Pain Free Hospitals: Changing Pain Management Through Policy Change in Malaysia

Jan 7, 2016

The Malaysian Pain Free Hospital (PFH) Initiative began in 2011 as a follow-up to the adoption of “Pain as the 5th Vital Sign” (P5VS) policy in Malaysian Ministry of Health (MOH) hospitals in 2008.

Although P5VS resulted in better awareness about the importance of routine pain assessment, there was not much impact on pain management practices in hospitals as the education on pain assessment focused mainly on the nursing staff. Recognizing the need to broaden the educational target group and engage with the different health-care providers and hospital administrators in improving patients’ pain experience in hospitals, we embarked on the PFH initiative, bringing on board not just anesthesiologists and pain specialists but also specialists from surgical and medical disciplines, allied health professionals, and nursing administrators.

The PFH concept has three main pillars—appropriate knowledge, quality assurance, and comprehensive patient care—with the goal of achieving pain relief as a basic human right. We used a low-cost model that could be implemented in any hospital, with the main components being education for health-care providers and patients and optimal utilization of existing facilities.

The Ministry of Health set up a national PFH committee, comprising representatives from all stakeholders; this committee developed standardized protocols and policies that any Ministry of Health hospital could adopt and adapt. We then initiated a process of certifying hospitals as “Pain Free Hospitals,” and this generated interest not just among those traditionally involved in pain management, but also among specialists from other disciplines, allied health professionals, and very importantly, nursing and hospital administrators. Support from the administrators was crucial to ensure the appropriate allocation of human and financial resources and to bring about a change in the culture of the hospital.

Over the past two years, seven hospitals have been PFH-certified after a rigorous audit process, and a number of other hospitals have expressed interest. Awareness about the importance of pain assessment has increased tremendously, and pain management practices are changing slowly but surely. We are now working on improving pain management at the primary care level by expanding the “Pain Free” concept to health clinics in urban and rural areas using the same strategy of introducing policy changes at the Ministry of Health level so that these changes can be implemented nationwide in a short period of time. 

Dr. Mary Cardosa, Head of Pain Medicine Subspecialty, Anesthesiology Program, Ministry of Health Malaysia; IASP Councilor


IASP is again offering grants through the Developing Countries Project: Initiative for Improving Pain Education. This year, in addition to the usual grants for focused education projects, we are offering up to three grants for projects specifically directed to changing health policy related to pain. This could be at a hospital, regional, or national level; could focus on any pain type or patient group; and will preferably involve influencing some level of government. The Pain Free Hospitals initiative is a great example of this type of project.

We look forward to receiving your innovative, creative submissions!

— G. Allen Finley, MD FRCPC FAAP, Chair, IASP Developing Countries Working Group