Worried over an alarming increase in the side effects associated with painkillers or analgesics, the Kenya Medical Association has come up with guidelines for dispensing such drugs, which it hopes the government will adopt.

The guidelines will affect the operations of pharmacists as well as hawkers who vend medicines through kiosks.

The first of their kind to be developed for paracetamols and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) like brufen, the guidelines are going to be used among the three East African countries. In fact, the presidents of Uganda Medical Association and Medical Association of Tanzania were part of the team that developed the guidelines.

Doctors who formulated the guidelines observe that paracetamols and NSAIDS are widely available without medical supervision. And hence they propose that prescription painkiller drugs should not be sold over the counter, and the pharmacists should understand the side effects especially in cases where they are abused.

"Pain is the most common symptom for which patients seek medical care. To manage it, one must establish a mutual trust with the patient and understand the nature of pain, relationship between its medical, psychological and social aspects," KMA says in the guidelines.

One of the medics involved in the drafting, Dr Githinji Gitahi says: "What we want to achieve with these guidelines is to have some sanity in the drug industry. The guidelines seek to solve the problem of abuse of NSAIDs as well as prevent the movement of such drugs from pharmacies to shops."

Painkillers or analgesic are drugs that relieve pain without making a person sleepy or unconscious. They are classified as non-narcotic painkillers like Aspirin and NSAIDS, narcotic painkillers that are further classified as weak opioids such as codeine and strong opioids like morphine. In the third group are adjuvant painkillers like steroids. Aspirin and brufen are some of the popular examples of analgesics and are some of those the guidelines tackle in depth.

The guidelines come after doctors have raised the red flag about increasing side-effects among their patients, especially peptic ulcers and liver toxicity related to abuse of painkillers. Others have shown problems with kidney, the nervous system, and skin, all related to abuse of painkillers.

Although there are no compressive national studies on the abuse of painkillers in Kenya, studies done elsewhere indicate that 60 per cent of peptic ulcer patients are victims of Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Recently, in an attempt to find out how serious the problem is among his patients, a Nairobi doctor was shocked to discover that about 65 per cent of his patients had peptic ulcers related to NSAIDS abuse. However, the doctor has refused to make the findings public, because they have not undergone peer review by fellow doctors. Such review will authenticate the results and declare them as valid in the field of medicine.

Nevertheless, doctors say with over 70 per cent of people who consult them experiencing pain as symptoms of underlying diseases, there is corresponding increase in the use of painkillers. Yet, a majority of these people, with increasing poverty, are opting for self-medication with drugs they have little information or no information on dosage and side effects.

In some cases, doctors claim, people are either taking pain-relieving medicines for a longer period at very high doses sometimes for conditions that do not require the medicine, or using a combination of painkillers when it is not necessary.

They however agree that lack of guidelines on the trade in analgesics in the country is to blame for the abuse, and the increasing side effects. A factor compounded by the government's poor post-market surveillance of the drugs.

Hence, it is hoped the development of these guidelines will help many doctors and those in pharmaceutical industry as they tackle pertinent areas on the use of painkillers. One such important area of the guidelines is providing advice to health professionals and the general public when it is appropriate to use or combine certain painkillers and for what conditions.

There are also cautions and advice on how different groups of people should use these painkillers. Special groups such as pregnant women, the elderly, people with arthritis, cancer patients as well as people with kidney and liver failures have been covered in the guidelines.

Among the elderly, although analgesics are the widely used medication, doctors warn that the rate at which they are cleared from their blood system is very slow. Therefore such a group is highly vulnerable to drug toxicity or development of peptic ulcers if painkillers are abused or taken inappropriately.

For pregnant and breastfeeding women, the guidelines recommend the use of paracetamol. But warns that if there is massive overdose of the same drug, it can result in liver poisoning of the foetus.