Pain experts declare access to pain management a fundamental human right

15 Sept 2010

Pain management experts from 84 countries have called for governments worldwide to recognize the rights of people to access reasonable care for acute and chronic pain.

At the first annual International Pain Summit in Montreal at the beginning of September, delegates issued a declaration asserting that access to pain management is a fundamental human right.

The Declaration of Montreal emphasizes that management of acute pain is inadequate for more than 50% of people in developed countries and 90% of people in developing countries, while chronic non-cancer pain, which can be triggered by surgery, injury or disease, occurs in at least one in five people worldwide.

As part of the 13th World Congress on Pain in Montreal, the International Pain Summit, hosted by the International Association for the Study of Pain (IASP), was created to call attention to inadequate knowledge of pain management techniques by most medical workers and the lack of national policies in both the developed and developing world regarding the seriousness of pain as a global health problem. The summit was the first global meeting about the crucial aspects of pain management, with a focus on advocacy and assistance for all countries to develop national pain strategies.

“The World Health Organization estimates that 5 billion people live in countries with low or no access to controlled medicines and have insufficient access to treatment for moderate to severe pain,” said Michael Cousins, MD, chair of the Summit’s steering committee and professor and director of the Pain Management Research Institute in Sydney. “With this declaration, it is our goal to ensure that countries have the knowledge and support to establish laws, policies and systems that will help those in pain receive fully adequate pain management assistance.”

The summit delegates, as part of their declaration of basic rights, also called for the assessment of pain to be included as the fifth vital sign, thereby ensuring that health care providers accurately recognize and assess all factors affecting a person’s health at any one time.

In its “Declaration that Access to Pain Management is a Fundamental Human Right,” delegates to the inaugural International Pain Summit proposed that all people:

1. Have a right to the access to pain management without discrimination.
2. Have a right to be both informed about how their pain can be assessed through the recording of a fifth vital sign, and informed about the possibilities for treatment.
3. Have a right to access an appropriate range of effective pain management strategies supported by policies and procedures appropriate for the particular setting of health care and the health professionals employing them.
4. Have a right to access appropriate medicines, including but not limited to opioids, and to access health professionals skilled in the use of such medicines.
5. Have a right to assessment and treatment by an appropriately educated and trained interdisciplinary team at all levels of care.
6. Have the right to a health policy framework that, in governing pain relief treatment in the social, economic and regulatory environment, is compassionate, empathetic and well-informed.
7. Have a right to access best-practice, non-medication methods of pain management (ranging from relaxation and physiotherapy methods to more complex cognitive behavioral treatment) and to specialist-performed interventional methods, depending upon resources of the country.
8. Have a right to be recognized as having a disease entity, requiring access to management akin to other chronic diseases.

Additionally, the declaration proposes that:

1. Healthcare professionals have an obligation to offer a patient in pain the management that would be offered by a reasonably careful and competent healthcare professional.
2. Governments and all healthcare institutions establish laws, policies and systems that will help promote — not inhibit — access to pain management.

Dr GF Gebhart, president of the IASP and professor and director of the Center for Pain Research at the University of Pittsburgh School of Medicine said, “This declaration signifies a historic day to advocates of pain management as well as those who suffer from chronic pain worldwide. It is our hope that, with this declaration, all countries will begin to develop policies and regulations regarding widespread access to pain management regardless of gender, race, age and other factors.”

The declaration was prepared with due regard to current general circumstances and modes of health care delivery in the developed and developing world. The IASP believes it is the responsibility of governments, those involved at every level of healthcare administration, as well as health professionals to update articles of its declaration as new frameworks for pain management are developed. However, failure to offer adequate pain management is a breach of a patient's human rights.

About the International Association for the Study of Pain

The International Association for the Study of Pain (IASP) is the leading professional forum for science, practice and education in the field of pain. Membership in IASP is open to all professionals involved in research, diagnosis or treatment of pain. IASP has more than 7,000 members in 126 countries, 84 national chapters, and 14 Special Interest Groups. Founded in 1973, IASP is a non-profit organisation governed by its council.

For more information see: www.iasp-pain.org