Pain experts declare access to pain management a fundamental
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
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:
- Have a right to the access to pain management without
- 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.
- 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.
- 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.
- Have a right to assessment and treatment by an
appropriately educated and trained interdisciplinary team at all
levels of care.
- 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
- 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.
- 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:
- 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.
- 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.
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