Philippine Medical Care: Pain Medication and Pain Management

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Pain management and pain medication in the Philippines. The Philippines has one of the more restrictive regimes in the world regarding medication for moderate to severe pain. If you’re considering retiring in the Philippines or having medical treatment there, this is something you should be aware of. Perhaps you’re perfectly healthy now, but as a retiree in the Philippines you may not always be so.  We know this from personal experience.  Carol had major abdominal surgery in Manila, was in quite severe pain, but was only given Advil-type pain medication despite her being in agony and her requests for something stronger.

The Philippines has its own “war on drugs”. It does not seem to be especially successful in combating the main illegal drug “shabu” (methamphetamine), but it has imposed such onerous requirements on doctors and pharmacies that for all practical purposes, strong pain medications are not generally available except through pain management specialists in the larger cities.  To prescribe opioids in the Philippines, a doctor must apply to the Philippine Drug Enforcement Agency for an S2 license.   Then the physician must purchase special “yellow” prescription pads from the department of health for P200 per pad. The DOH threatens penalties of 12 to 20 years in prison for “unnecessary prescriptions.”  The death penalty may be imposed on doctors or pharmacists if they are found to have improperly prescribed pain medication.  Is it any surprise that only 4% of the 86,818 physicians possess this license?

The sad fact is that most Filipinos in severe pain can’t afford pain management specialists and do not get effective pain medication except over the counter drugs. I was at the small drug store in Tigbauan when someone came to get ibuprofen (Advil) for a relative dying of cancer. Many or most Philippine cancer patients die in agony. A survey conducted by the Philippine Cancer Society indicates that 65% to 75% of the 37,623 cancer patients who die annually experience unrelieved pain. According to the International Narcotic Control Board, straight-laced Singapore doctors dispense 220 times as much morphine to cancer patients as do Philippine doctors.

There are cultural differences.Filipinos may accept severe pain as part of living and dying.Few foreigners would like to face such a fate.My sister died of cancer when she was young. Even with Demerol the pain was terrible.Combating drug abuse is a worthy goal, but a system that keeps pain medication from patients in severe pain is unconscionable.

If you live in the provinces there will probably be no physician able and willing to prescribe pain relievers and almost certainly no pharmacy which will dispense them.  This means frequent trips to a pain management clinic in the nearest city which has one.  This was so unworkable for the terminally ill mother of one foreigner that they had to leave the Philippines.  There was a recent report of an American in such terrible pain from prostate cancer that he killed himself.

The maximum number of controlled substance pills is capped at thirty per prescription, even if multiple pills are needed per day.  Prescriptions expire if not used within thirty days.  Some physicians may write multiple prescriptions so that the patient need not come in so often.

As is true elsewhere, doctors are suspicious of writing prescriptions for controlled substances and drugstores careful about filling prescriptions.  Be sure to bring detailed information from your home country doctor about your condition and medications.  This will reassure your new Philippine physician.

As noted above, Carol had surgery at Manila Doctor’s Hospital.  Overall, our experiences were very good.  You can read the whole story HERE.  The one disappointment was the adamant refusal of our surgeon to prescribe adequate pain medication, even after major surgery.  No compulsory instruction in palliative care is available in any Philippine undergraduate medical program.  If you are having surgery, we suggest making the hospital’s pain management specialist a part of the health care team before your surgery.

Our one beef regarding Carol’s care was inadequate post-operative pain medication. This is not the fault of the hospital. It has to do with Philippine paranoia about using opioid medications, even for surgical patients. Post-op Carol was given a NSAID “Arcoxia”. It’s similar to Celebrex or ibuprofen. Arcoxia is not approved for use in the U.S. because the manufacturer has not been able to convince the FDA that it’s effective or safe. Carol suffered due to lack of effective pain control. A few days of opioid pain killers would have been far more effective and safer than the Arcoxia.  The idea that should would have become a drug addict from three or four days of morphine is ridiculous.

Dental surgery.  If you have dental work in the Philippines, no matter how severe, the dentist will almost certainly not provide pain medication.  You will be sent to Mercury Drug to buy an Advil-class NSAID drug

Since this post was first written in 2008, a couple from the U.S. visited us.  One of them had severe spinal pain.  They were interested in life in the Philippines, but were concerned by what they read on this site and elsewhere about pain management and pain medications.  To their credit they contacted pain management specialists in the Philippines and then came to the Philippines to meet with doctors and do their own “due diligence”.   What they learned in encouraging, at least for those that live in or near a city with a pain management specialist and who can afford the medications. Thanks to them for sharing their experiences. Here is their report.

Pain Management in the Philippines, our experience

“I have been reading the responses here and on other sites as well for several years in respect to pain management and medications available in the Philippines. My wife and I have been considering a move to the Philippines; she unfortunately suffers with severe pain and most likely will for the rest of her life so the issue of pain management is a major issue. Due to the many conflicting comments we have read, we decided to visit the Philippines, meet Doctors and find out how this applies to us.

We made contact with the Pain Management Society of the Philippines and based on our potential locations got a recommendation to a Doctor and subsequently have received several more referrals in the Metro Manila area and Bacolod.

February/March 2010 we spent 18 days in Iloilo, Panay and met with the referred Doctor an Internal Medicine – Pain & Palliative Care Medicine, at Iloilo Mission Hospital. The Doctor was very interested in the medical documentation we brought with us and reviewed our case, she spent almost an hour and a half with us on the first visit. She reviewed the medications used  in the U.S., Lortab / Hydrocodone 10mg/500 4 X daily (for Pain), Soma / Carisoprodol (Muscle spasm) 350mg, 3 X daily, and Methadone (Pain) .05mg 2 X day. Pretty powerful stuff and we are not thrilled about them but there is a real need.

The Doctor explained that these medications are not available in the Philippine’s, we discussed the attitudes of the Philippine Government and Medical professionals in the country and what is being done to make changes there. She explained the controls for pain management drugs and what is available and how it can be prescribed and used.

We were prescribed Morphine Sulfate 10mg 6X daily for the pain management aspect and Lagaflex 20mg, 3 X daily for the muscle spasms and we discontinued all the U.S. prescribed medications.

I mentioned to the Doctor that I have read that such prescriptions are only available for 8 days at a time; she explained how the prescriptions and strengths are controlled. With the Morphine Sulfate at 10mg, the maximum number of tablets is 100 at a time. If the prescription is for 5mg the max would be 200 and with 20mg, maximum would be 50 tablets.

So with a prescription of 10mg, 100 tablets, at 6 X per day we have 16 days with each prescription.

Lagaflex is similar to Soma but not the same, it has different compounds and works in a different way but is intended to have a similar effect.

We found the combination of both medications a bit too strong and reduced the Lagaflex and then discontinued it for most of the time. Laura found sufficient pain control with just the Morphine.

We got a 6 day prescription on the first visit to see how the change might affect her and returned for a follow up visit and refill. In all we saw the Doctor three times during our stay in Iloilo and Tigbauan, each visit the Doctor spent a long time talking with us and showed a real concern.

We brought a letter back with us describing the care provided and medications prescribed for our Doctor here in the U.S., he of course wasn’t interested in what was prescribed there and explained that the Morphine available here is not available in the same dosages and would not be able to prescribe its use at this time.

So, we were able to meet my wife’s pain management needs in the Philippines and to have the care of skilled and caring Doctors.

The Doctor even suggested that if we wanted to move to Bacolod there is a good Pain Management Doctor there. We met with the Nurse that is assisting with the Medicare program being offer in the Philippines and were given 7 referrals in the Manila area. There are many other Pain Specialists in the country and the assistance we received from the Pain Society was invaluable.

We feel the change in life style we can achieve in the Philippines may lead to a better overall health aspect and ultimately be able to reduce the level of medications necessary.”

Pain Society of the Philippines

The Garden Heights Condominium, Unit 205

269 E. Rodriguez Sr. Avenue 1102

Quezon City, Philippines

0063 2 721 2700

Further reading:

http://www.eolc-observatory.net/global_analysis/philippines_opioid.htm

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1071118

http://www.medobserver.com/janfeb2007/viewpoint.html

http://services.inquirer.net/print/print.php?article_id=20080815-154942

http://www.nytimes.com/2007/10/09/health/09pain.html?ref=health

http://www.hrw.org/node/98902/section/16

Comments (63) Write a comment

  1. Hi Bob @ Carol, thumbled upon your lovely page today. I live in canada and married to a philippina, she has permanent residency in Canada. Planning to go to philippines for 4 months, i get prescribed Hydromorphone 4mg 8 times a day for back pain, no issue whatsover here with my doctor or drugstore to get 4 months in one time before i leave. I am just wondering if they will be issues if i show up with 800 hydromorphone 4mg pills in manila ? With copies of prescription and letter from my doctor ? Much appreciated , cheers!

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    • Dennis, chances are you will never be asked. If your luggage is searched and you have a valid prescription, you still should be fine. Morphine is legal and available in the Philippines, subject to controlled substance procedures.

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  2. I’m going to be traveling to the philippines this year and I’m wondering if there will be an issue with my medication. I take oxycodone 30 mg and tramadol 100 mg. Does anyone know If there would be an issue

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    • My opinion, as long as the quantity is reasonable and you have and can produce a prescription, you are unlikely to have a problem.

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      • Yes Bon & Carol I read your blog and it’s very informative, I will be in the Metro Manila area and my new wide like most there doesn’t know much about pain management, can you email a list of pm physicians in the metro area?

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        • I just came over from the states and I am on hydrocodone. Yes mild but still needed. I stocked up in the States and brought with in original pharmacy bottles right in my carry on
          I have not located a S medicine specialist yet but I understand that is what you need here.
          Also the pain meds if available are VERY expensive! I think minewmine were like 18000 pesos per month?
          I’m in Cebu and manila is probably better yet for locating this type of specialist. You can’t use just any doctor.

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  3. Hi, I went recently to Manila and met my wife, we are now married, I’ve had lower lumbar spine fusion and my pain management doctor treats me with percocet 10/325 and my nurse practitioner prescribes me zanax 1 MG ,my pain med 4×day and zanax 2× day,in the U.S while I was in Manila I ran out of my meds and not good, ,,I will be going back and forth until my new wife can come here or we establish and settle thete, can you advise me what to do to receive my meds there in Philippines? Also, I didn’t have any problems in December bringing my meds with me, is there anything I need to know concerning bringing what meds I can with me? Thanks so much and I enjoy the comments and advice.

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    • Kevin, regarding bringing medications for your own use it’s usually not a problem. It’s best to have copy of your prescriptions to show if any questions are asked.

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    • one can get some med there that are not aviable in US,I use genric soma for muscles,it works good and in philippines its called Lagaflax.any pharmacy!

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  4. Im going to say one thing in defence of the PH pain medication policy but first i make it clear that i think they violate human rights by not giving dying people real pain medications and that it should be brought before the Haag and economic sanctions imposed on Philippines if they dont make it available also to regular people who arent filthy rich. Its torture and must be stopped.
    BUT i have been in bad accidents, and had surgery and many painful injuries, including a month of excruciating pain with a badly pulled groin. Sure, the suffering has been severe but i never needed or wanted anything strong, even if i could not sleep for days due to the pain. Cancer patients however, have much worse pain and need real pain medication, they are going to die no matter what and will not get addicted, theres no reason to be so extremely restrictive.

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    • well in the philippines you go to Hosp ,you better have meds,the Hosp has none for you,some family must go outside for your meds.True if you need pain med best take with you there,I always did and had the scrip from the dr.and pharmacy to be safe.living there 20+ yrs I never had a problem taking them in,just email my son also have hin get them filled,send them to me by mail,I had a priate mail service through Fed X.

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  5. Should add, just like Tramadol, which is easily had even in the provinces, there is Nubain, nabulphine hcl. Like Tramadol it only works on a select few. Tramadol comes in all forms but Nubain is only injectable. Like Tramadol it requires prescriptions in some areas, especially on Cebu where it has a strong illicit market.

    Reply

    • A few years ago, Tramadol was available without a prescription in Iloilo City. I found it to be ineffective. I believe it is no longer available in the U.S., with or without a prescription due to adverse side effects.

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      • Bob and Carol, tramadol is still around in the USA but basically in the veterinary field the last I knew. I tried it and tried to get it here in Lapu Lapu but a prescription was required. And it is generally ineffective on me as well.
        I am a transplant patient and even in the USA can only get a 30 day prescription, it had to be written and I have to go to the Dr to get it. I take hydrocodone medium strength and c ant take NSAIDS because of the transplants.
        I have seen there are pain med doctors (S2) here in cebu but have yet to go see one. I brought a good supply with me without trouble.
        I would however be very interested to know about where these types can be gotten overseas that are mentioned here.

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        • Andy, reputable international pharmacies never sell controlled substances. There are some less reputable ones which claim to do so. In any case, importing controlled substances could get you in serious trouble. My advise, just stick with a Philippine physician with S2 authorization. Physicians other than pain management specialists can have S2 authorization. I too find Tramadol to be worse than useless. I am not supposed to take NSAIDS either, due to a heart condition, but I take them anyway as I don’t like opiates, unless the pain is impossible.

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  6. Until 1972 the Philippines was like any other nation. That year Marcos iniated a war on drugs and executed a Tsinoy heroin manufacturer (Lem Seng). Availability of illicit opioids pretty much ended. To stop addiction Marcos had ALL licit opiates/opioids removed from the national pharmocopiea as well.

    Fast forward to 2004 and the UN’s WHO threatened the Philippines forcing it to re-introduce licit opiates/opioids.

    To settle the issue the Philippines took WHO’s three rung pain ladder: NSAIDs, Light Opioids, Strong Opioids, and converted it into a two rung system that only has NSAIDs and Strong Opioids (Demerol, Morphine, Oxycodone and Fentanyl). In 2009 the nation planned to re-introduce codeine as well as hydromorphone but as yet hasnt followed through.

    What to do? Simply find a physician with an S2 liscence. It is alot easier than many commenters claim. Simply ask any physician for a colleague with an S2.

    Morphine, locally made (Hizon Labs) comes in 10, 20 and 30mg instant release tablets, as well as injectables. Demerol is injectable only. Fentanyl is injectable and transdermic patch. Oxycodone is instant release from 10 to 80mg tablet. All but Hizon morphine is extremely expencive, P32,000 for 18 tablets of 10mg Oxycodone instant releas,. Mundipharma, a French import as an example. Hizon morphine is 100 tablets of 30mg for just under P4,000.

    Outside the cities it wont be found. Even in the cities a couple of Mercury branches and hospital Rxs only and then only 3 boxes (3,000 tablets total) maximum with it taking up to 6 weeks to restock.

    Reply

    • Jon, Thanks for this excellent and fascinating background information. As far as I know that is not much of an opiate addiction problem in the Philippines, but instead there is a terrible methamphetamine problem. Addicts will commit crimes to get money to buy drugs but I would prefer opiate addicts who generally don’t display the wild behavior that can come with meth. Only a few decades ago, Iloilo City had opium dens. Customers would come to the dens, recline on a bed and be given a pipe of opium and then drift off into their opium dreams.

      I have often been puzzled why the choice in the Philippines was between NSAIDs or Morphine. The lesser pain relievers such as codeine, hydrocodone and so forth are just not available. I was furious with my wife’s surgeon when she was given a NSAID for postoperative pain. She just had to endure the pain despite pleas for something stronger, at least for the first few hours. If you want stronger post-op pain medication I suspect you’ll have to have a pain management specialist on your team.

      It will be interesting to see how the new Philippine administration deals with prescription drug policies.

      Thanks again for your post.

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  7. Tramadol (opioid painkiller) sold everywhere without prescription . …generic at the local family pharmacy about 150 PHP For 10*50mg. Brandname at masons for about 500 PHP.

    If you need something really strong like oxycontin I guess it can be a hassle. But it would be the same in my home country sweden to. Very hard to get prescription for strong medicine. .

    Reply

    • Tramadol requires a prescription in some cities, such as Cebu City. I never found it to be all that effective and it’s been pulled from the market in the U.S. due to safety concerns. If you really ned pain meds in the Philippines, it’s best to go to a doc specializing in Pain Management. If I ever had surgery in the Philippines, I’d have one as part of my medical team.

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  8. I am looking at the idea of moving to cebu city philliphines. Due to a car accident ive been seeing a painanagement doctor sense 2003. And I am on hydrocodone + gabagabapentin a nerve blocker. I read these articals. Would you please recommend a very good pain management doctor in cebu city please so I can get this rolling before I head to cebu in january. Because I am going there for 3 weeks and have to bring my pain meds with and then I can meet with them when Iget out there. Thsnk you Joseph Johnson

    Reply

    • Joseph,

      I too have a cervical condition. Cebu is a good choice for you. Chong Hua Hospital in Cebu City is excellent. I have been a patient there and the care was good. I can recommend that you see Dr. Jamie Rama who has an office at Chong Hua Hospital. He is not a pain management specialist. He is head of neurosurgery and a very nice and competent guy who can refer you to a pain management specialist at Chong Hua. A referral from Dr. Rama, along with your medical records will help the pain management doctor meet your needs.

      You should not have a problem bringing your meds. Bring as much as you can. Keep them in the bottles with the pharmacy label and a copy of your prescription. A letter from you doctor outlining your medical condition and medications would be very helpful. Gabapentin is definitely available in the Philippines as are pain medications.

      Good luck,

      Bob

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    • If you can afford its highly advisable to go to Hong Kong or Singapore when you need more than the simplest medical attention, thats what rich filipinos do, they have valid reasons for not trusting the Philippine system. Dont get seriously ill in PH, the doctors are ok but the system is extremely flawed. Have you considered Indonesia? Happiest expats in the world.

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  9. This has been a very interesting read for me and has obviously gone on over a number of years. I am a disabled American considering retiring to the Philippines due to cost of living. That being said, I have done my research on all of my basic meds and the one I am concerned about is a 5/500 hydrocodone pain killer. I am “forced” more or less to use this mild pain killer (don’t really like it but…) because I am a transplant patient (double) and can’t use Nsaids.
    I have seen that one question has not really been answered here.
    Can I bring a present supply/prescription in with me?
    This will give me enough leeway to see a pain management specialist on arrival.

    Reply

    • Andy,

      It’s unlikely that you’ll have a problem. Just bring it in a drugstore bottle with label. You’ll want a letter from your doctor describing your condition and the medications you are prescribed. You’ll want the letter to show your Philippine pain specialist. Bring as much hydrocodone as you can because it’s unlikely you’ll find it here. There are substitute opiate pain meds available. Ironically, many are stronger. You might get oxycodone, morphine or methadone tablets as an unwelcome substitute for the milder, but unavailable hydrocodone. Not sure if it works for you, but Ultram/Tramadol is available without a prescription in most places. Here it’s considered safer, that is less addicting. Actually it’s less safe. Make sure you doctors in the Philippines know you can’t have NSAIDs. They like to give those for postoperative or dental pain management.

      Good luck,

      Bob and Carol

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    • Andy: philippines does not take pain serious,I lived there 20 yrs,customs can do what ever they want,let you go or take all,I had a mail service out of angeles city,my son sent my meds through this service and carried through FedX at a special cheap rate to my door.never had any taken away over the yrs,but there its day by day with them.

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      • Hey George, Just wanted to let you know I have made it here and I actually made it through customs with no hassle (or check) at customs in Cebu.
        Now I had wheelchair assistance so perhaps that was the difference?
        The big one for me is not the pain meds (yet) but one of my anti rejection drugs. I bought it just to see if I could get it. Yes, I could! At 28,400 pesos a month!
        That will greatly inhibit my ability to stay here so I’m glad I brought about an 8 month supply with me.
        I am checking into avenues for shipping from the USA but just a warning to transplant patients.
        Be prepared!

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  10. I’m sorry to read this as I have been planning on retiring to the Philippines in a few years but I also have chronic pain issues, including the L4/L5 disc in my spine which is almost gone and the resulting pain from sciatica and back spasms is agonizing.

    After several years on various narcotic meds that just created a higher tolerance, a PM doctor put me on Methadone, Valium and a few other meds.

    I see the PM doctor 1x per month and he writes out the prescriptions for me.

    I can’t imagine retiring to the Phils and having to jump thru a million hoops to find a doctor and then another million hoops to find a pharmacy that keeps the required meds in stock.

    I was planning on retiring to a province about 75 miles or so south of Cebu City.

    If the Philippines wants to attract retirees, they should resolve this issue with pain meds.

    Now I know why so many Expats sit in a bar all day drinking San Mig’s – they are likely in pain and alcohol is the cheapest and most available “pain killer” but not the most effective.

    I’m really disappointed as I’ve been planning this for the last year and just started thinking about the medical aspects of life in the Phils and my research has shown that if you have chronic pain, the Phils is not the place to retire.

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    • Pete,

      Frankly, I don’t think the average Filipino cares whether we foreigners come here or not. I think it’s a pride thing. They will be quite hospitable if you do come, but they are not going to beg you to do so, or change the way they do things to suit you.

      I do think the pain situation with pain meds is doable once you have a pain management doc. Once they have trust in you they may well write you multiple prescriptions per office visit.

      I know the area south of Cebu City. It’s gorgeous, but I don’t think it’s practical for the foreigner with medical problems, (and if you don’t have problems at present you will as you age.) I know. I have to go to cardiologists, pulmonologists, endocrinologists, dermatologists, urologists, and so forth. I am only 30 to 45 minutes from Iloilo City. Your drive from south Cebu will take at least two hours each way, probably more. Traffic and parking will be a nightmare. Waiting times for doctors can be interminable. You will have no emergency medical services available. You will be hours away from a drug store having what you need. I personally know foreigners who built houses in impractical locations and as medical issues worsened they had to abandon their dream homes.

      Cebu City and Metro Manila are best for foreigners with medical issues. Chong Hua Hospital in Cebu City seems first rate.

      Hope this is helpful! Best wishes.

      Bob

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  11. I am experiencing this difficulty right now as a chronic pain patient suffering from Thoracic Outlet Syndrome. I will need to see a Pain Management specialist in Tarlac or Manila both many kilometers from my home in San Jose City, Nueva Ecija. I did find a local doctor who was willing to right me a one time only prescription for Oxycodone. My Methadone base medication is not even available here, and the local pharmacies do not stock Oxycodone. Even getting my Ibuprofen in 600 mg strength has proved to be problematic as I have only been able to find that dosage in Manila. Luckily the local pharmacies do stock Cymbalta my other base medication but it is very expensive. I am also lucky in that one local pharmacy is attempting to locate a supply of Oxycodone for that one time prescription I mentioned, but in order to continue getting it and have them order and keep a sufficient supply in stock, I will be required to travel to see a pain management specialist. I had a pain management specialist in the US who consulted with my primary care provider who was a Nurse Practioner. I saw her monthly and the specialist quarterly. In the US my Nurse Practioner was able to write my prescriptions for all of my pain management medications. Methadone, Cymbalta, Ibuprofen, Baclofen, and Oxycodone. I was on a pain management medication contract as is the typical practice in the US. I can’t believe how crazy the prescription drug market is here, and the fact that pain medications are so hard to come by even for surgical and cancer patients. This needs to change. Maybe I will write a letter to Senator Miriam Santiago. LOL

    Reply

    • Andrew,

      Thanks for sharing your story. Yes, the pain management situation in the Philippines is very difficult. I was in our small town pharmacy. The lady in front of me was buying ibuprofen for a parent dying of cancer. The parent was lucky that her child could afford ibuprofen. I am certain that the pharmacy does not stock anything stronger, even for cancer pain. Pain management specialists and pain medications are for the well-to-do.

      Sometimes foreigners coming to the Philippines when they are in good health do not give enough consideration to the fact that they will not always be healthy and locate in areas where medical care is a problem.

      They think more of good beaches than pain management specialists! I am not being critical here. I was guilty of the same thing, to some degree. It’s human nature.

      The key is to establish a relationship with doctors who have the license and the willingness to prescribe the drugs you need. As trust builds up, they will find ways to make your visits less frequent, such as giving you multiple prescriptions on a single visit. You might also try anesthesiologists as well as pain management specialists.

      In Iloilo, a medium sized city, you can get most of the medications that are available in the Philippines, but of course, many medications are just not available here. You might have to go from pharmacy to pharmacy to find everything you need and the prices are high.

      Good luck,

      Bob and Carol

      Reply

      • Oh my god, ibuprofen for cancer, its like torture, no wonder filipinos with cancer die many months prematurely, the pain must be so unbearable that the body decides to die to stop the unspeakable suffering.

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  12. Sounds terrible! I’m about 10 years away from retirement and had some thoughts about retiring there with my wife (who is from Philp). But I take medication for chronic pain (not the real heavy stuff). But from the sound of it, heavy enough to get excluded from their rules involving controlled substances).

    Reply

    • Paul,

      Paul, if you settle in or near a larger city, you may be OK. There are pain management specialists who can prescribe pain medications and there are pharmacies who stock the medications. The selection of medications is less. A neighbor of hours made a reconnaissance visit, including bringing medical records and meeting with pain specialists. They were satisfied and moved here. Things are going well for them. It may be easier in the U.S. and your medications may be covered by insurance but then there are numerous advantages to living here.

      Bob

      Reply

  13. i had dental surgery in the philippines due to the drastic nature and associated cost of what i needed done. In addition to that work, i have a chronic pain condition from two major auto accidents which i went through the windshield of the car. I am on very strong pain meds in the us, as i have titrated up to these levels over a twelve year period. I found out the hard way that you CANNOT get any kind of opiod pain meds in the philippines without either paying a shady doctor in places that you may get kidnapped knowing you are bringing him tons of cash in eschange for the meds, or you must beg and plead with a manila doctor specializing in pain management, and they are almost noon existant and when you do find one, good lluck getting anything near what your system is used to from US doctors. I had to cut my trip short, pay the airline more than the original price of the ticket to get back home to fill my perscription and was in complete withdrawl and agony on the 24hour plane ride home. I STRONGLY SUGGEST THAT NOONE GO TO THE PHILIPPINES FOR ANY MEDICAL PROCEDURES THAT MAY CAUSE THE SLIGHTEST AMOUNT OF PAIN. Further, if you plan to live there (I am married to a filipina and building a house there) you better have enough money to fly back and forth to a country that does perscribe pain meds, or not have any need for them and no reason to believe you will in the foreseable future. I have been flying back and forth from US to phil every other month. as soon as we get her visa she will live in america, STRICTLY becuase of the pain medicine situation. SO SAD to have to say this, other than this one problem, the philippines are a beautiful place to live with wonderful people and incredible beaches. But that is my very STRONG advise to anyone considering living here.

    Reply

    • Kirk,

      Thanks very much for sharing your experiences and frustrations regarding pain medication and management in the Philippines. While we do have friends who have managed to find a pain specialist and pain medications, the situation in the Philippines generally is at least difficult or impossible.

      Many pain medications are not available at all and 99% of physicians and most pharmacies are terrified of prescribing or dispensing pain medications, even after major surgery, as my wife can attest. So, I agree, if you have chronic pain requiring opiate medications, the Philippines should probably be crossed off your list. If the Philippines is serious about medical tourism, this has to be addressed.

      Bob

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    • I read the above story wherein the writer states:

      “We feel the change in life style we can achieve in the Philippines may lead to a better overall health aspect and ultimately be able to reduce the level of medications necessary.”

      I don’t know what you have been reading or smoking, it simply is not true. I strongly suggest that you do lots of reading and lots of talking to people who have actually decided to live here.

      Good luck

      Reply

    • Absolutely, any kind of surgery in ph is out of the question, thats why filipinos with money go to hongkong or singapore for surgery. My wife had a surgery in manila and was prescribed voltarol for the pain, as everyone know it dont help at all, it was worse than torture. I thought it was a violation of human rights, is it legal to treat people so poorly and have such disrespect for people in agonizing pain? The system should have been put on trial in Haag.

      Reply

  14. I am so outraged at the Philippine Government for letting their citizens suffer in pain. “A survey conducted by the Philippine Cancer Society indicates that 65% to 75% of the 37,623 cancer patients who die annually experience unrelieved pain.” After reading this article my staff and I will lobby the US government not to extend US medicare to the Philippines until they are compliant with US laws regarding Pain Management. Further more, opioids are so expensive in the Philippines that its an embarrassment to the country and catastrophic to its people who truly need pain management. I say shame on the Philippine Government, shame shame.

    Reply

    • Youre right, the legalized and extreme torture of seriously ill people is a violation of human rights and should be brought before the Haag.

      Reply

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  16. I’m a US trained pain specialist dual board certified and I do lots of international work in Latin America teaching doctors and other medical providers about pain.

    I would be interested in teaching basics and advanced pain management techniques to the docs in the Philippines, either in Manila or other cities. Does anyone have contacts or additional information?

    Reply

    • Dr. Palma, we suggest that you contact the Pain Society of the Philippines
      The Garden Heights Condominium, Unit 205
      269 E. Rodriguez Sr. Avenue 1102
      Quezon City, Philippines
      +63 2 721 2700

      They should be able to suggest how your skills and generosity could be put to good use.

      Reply

  17. I was shocked to see that only 4% of the Physicians here can prescribe the stronger pain relievers. Having seen people suffer with cancer and other serious illnesses before bak in the UK, I would not like to think how much worse it is for them to have been without morphine or similar.

    Soon I will need a repair or replacement of the Mitral valve, but have been told that the repair option which uses keyhole surgery is not available in Philippines. I guess I will book a trip to Singapore or Thailand to get this valve repair done rather than face open heart surgery.

    Having also read that Philippines is now being promoted as a “medical tourist” destination, perhaps the doctors and hospitals will need to realign their fees charged to travelling Foreigners and Expats (Permanent Residents)

    Excuse the pun, but I have been “stitched up” before with the outrageous fees charged here by one Oral Surgeon, it will not happen again while I am able to get on a plane and travel to other countries. Yes, operations are obviously cheaper here than large American Cities but there are cheaper, cleaner hospitals in the likes of Singapore and Belgium, Germany who all welcome medical tourists.

    Reply

    • Our experiences with “Manila Docs” was 100% positive, except for pain management. It seems that Philippine medical students don’t receive proper training in pain management and that if you want to have proper post-operative pain management you have to arrange it with a pain management specialist before surgery. I am still unhappy with the callous attitude of our otherwise excellent surgeon. Carol really suffered after her surgery. There is no excuse for that. Many Philippine doctors seem to think the patient will become a drug addict if they receive the post-op opiate pain medication which is routine elsewhere.

      Reply

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  19. can i bring my hydrocodone and valium from the us-va clinic to the phillipines? or get them there?

    Reply

    • You can get them from the VA outpatient clinic as I get both if your condition is service connected.

      Reply

  20. Hello, I’m not familiar with any other area besides Cebu, but would just like to say that the Cebu Cancer Center at Perpetual Succor Hospital in Cebu City, deals with all aspects of cancer, including pain management.
    I hope that this information might be of help to someone…

    Reply

    • Cebu and its doctors are subject to the Philippine laws regarding pain management and the dispensary of narcotics. You need to explain your self in detail for people of this forum to fully understand of your circumstances.

      Reply

  21. I find this info about pain management incredibly helpful. I stumbled upon this site as I was desperately trying to find a pain specialist in Iloilo City for my father who has just been diagnosed with Cancer. And I must agree that if someone lives further away from the city where a pain specialist is unavailable, whatever quality of life that people with chronic pain have left will be spent in agony. In the presence of all these evidence that pain is not addressed thoroughly in the management of patients in the Philippines, the Department of Health should step in and intervene if they would like to project the country as a medical tourism destination.

    Reply

    • If this country wants to be a medical tourist country they need to
      have pain management.

      Reply

      • Yes, I wish I had gone to pain management department and gotten them involved BEFORE Carol’s surgery. Supposedly the Philippines wants to encourage medical tourism. A first step is to improve pain management in and out of Philippine hospitals. At this point the patient has to take the initiative, otherwise it’s Celebrex post-op.

        Reply

        • Medical tourism here in the Philippines is nothing more than a dream and would soon turn into a nightmare for anyone coming here for such a reason. Haven’t you ever wondered why most wealthy Filipinos seek medical treatment outside the Philippines?

          Reply

          • You are of course right, when i first heard of Philippines and medical tourism i was sure someone had misunderstood and got it backwards, because as you pointed out already, there is medical tourism OUTGOING Philippines, there will never be any inbound. Its not that the PH doctors are so terrible, its the incomprehensible level of mismanagement at he top levels, including the doctor education that is far below even MIddle East level. Some european countries used to allow doctors from Philippines but that was stopped when they discovered that their level was very much below doctors from.. Wait for it… INDIA, believe it or not. Good doctors in Philippines from the most expensive specialists studies are very good but they are also very rich and have no need or desire to go abroad to work for less money. The surgeon i have used in PH owns his own private hospital with all facilities and more equipment than the big public hospital 200 meters away, he is considered one of the top surgeons in the country and good for hundreds of millions Peso, thats a hundred million reasons to not go abroad, and my point being that Philippines only exported the inexperienced doctors from the cheapest medical schools.

            Reply

            • I have to agree with you regarding medical tourism in the Philippines. Many well-to-do Filipinos and expats head to Thailand or Singapore. I had to go to Singapore to get a test which was just not available in the Philippines. That said we are quite happy with the doctors we have in Iloilo. When Carol needed major surgery, we had it done by a UP surgeon at Manila Doctor’s Hospital. The care was good. We were very satisfied. If we needed complex surgery, say spinal surgery or CABG we’d probably get it elsewhere. For CABG I’d be tempted to try India which has developed production line CABGs with very impressive results. But, we are fine with our routine care in Iloilo. Some of the doctors were trained abroad and could practice abroad. Some don’t want to leave the Philippines. Several of the best split their time between treating private patients and working in public hospitals treating the poor. They are truly decent people.

              Reply

      • Many Doctors I know in Philippines are going to Nurses school give up practice and off to US or other parts,but some still hold office hrs on weekends and day off
        as Doctors.!

        Reply

        • I didnt know PH doctors can get a license in USA, they can no longer get any in Europe. The wife of one of my Filipino friends is a doctora and said she could not work abroad except as a nurse, its strange she didnt know she could practice medicine in USA from a private office. Not sure i am buying your story, maybe they operate only as quack within the limits of what USA allows for non-licensed doctors.

          Reply

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