WMA Statement on Access to Adequate Pain Management

Adopted by the 62^nd WMA General Assembly, Montevideo, Uruguay, October 2011
and amended by the 71^st WMA General Assembly (online), Cordoba, Spain, October 2020
and by the 77^th WMA General Assembly, Rotterdam, the Netherlands, October 2026

PREAMBLE

Pain is a complex perception consisting of physical, psychological, social, cultural and spiritual sufferings, and access to appropriate pain treatment is a human right.

Yet, around the world, tens of millions of people experience moderate to severe, and sometimes prolonged, pain without access to appropriate treatment. Those who may not be able to adequately express their pain – such as children, people with intellectual disabilities and those with altered consciousness– and individuals and populations that have historically been undertreated for pain due to bias, are especially at risk of receiving inadequate pain treatment.

Inadequate pain treatment contributes to individual suffering physically and emotionally, impacts the patient’s family and others close to the patient, and causes care burdens and negative economic impact on society.

In many cases, pain can be stopped or relieved with simple treatment interventions, which can dramatically improve the quality of life for patients.

Sometimes psycho-emotional factors are even more significant than physiologic factors. Pain treatment in these cases may require a multi-faceted approach to care by multidisciplinary teams.

As documented by the 2023 World Health Organization “Left behind in pain” report, the use of opioids to treat pain has seen significant growth in some countries, while in many other areas around the world, access to such treatment remains limited. Even in countries with a high volume of opioid use, it can be difficult for specific populations to receive adequate treatment for their pain, such as in palliative and end-of-life care where opioid access gaps can be significant. Incomplete pain assessment or improper use of pain medication, including overuse, abuse, and addiction, can bring about adverse drug reactions. All of these are very important and urgent issues that need to be addressed. These challenges highlight the need for balanced, evidence-based and patient-centred approaches to pain management, ensuring access to effective treatment while preventing avoidable harm.

RECOMMENDATIONS

Pain treatment education

1. Evidence-based education on pain management and control best practices should be provided to physicians and other health personnel, beginning with undergraduate education through to continuous professional development activities. Education should also acknowledge where there is a lack of evidence supporting pain management practices.

2. Education should include pain assessment and evidence-based pain control. This includes information about the efficacy and risks of pain medication, including the action of opioids and adjustment and conversion of opioid dosages; the risks of bias and under- and over-medicalisation; and the prevention of inappropriate prescribing, adverse reactions, addiction, and overdose. Patient-centred care should be taught to fulfil the goal of adequately stopping pain and reducing the incidence of adverse reactions, addiction, and overdose. The curriculum should be competence-based in design to enhance the knowledge, attitude, and skills of healthcare professionals treating pain.

3. Education should also include training and guidance on navigating controlled-medicine regulations (including procurement, prescribing, dispensing, documentation, and reporting requirements) and practical strategies to prevent diversion and non-medical use while safeguarding timely access for patients with legitimate need. 

4. Pain treatment education for medical professionals should include non-pharmacological treatment options. Education should enable them to develop proper interpersonal communication skills, a thorough understanding of cultural differences, and the ability to evaluate the overall pain suffered by patients in its physiological and psychological dimensions. It must also facilitate integration of these skills throughout multidisciplinary teams, so that professionals can work together to alleviate patient pain with and without medication.

5. Education should support the development of pain and palliative care specialists, who can effectively support first-line physicians and other health personnel.

Physicians and other health personnel

6. The practice of pain management should be physician-led and include:

• Comprehensive assessment of the patient and diagnosis of the cause of pain, including maintaining cultural competence in pain assessment, especially when serving diverse populations where pain expression varies or could be influenced by stigma.
• Evaluation of treatment options and selection of appropriate treatment options in a shared decision-making process, including both pharmacological and/or non-pharmacological interventions.
• Termination of prescribed treatment options when appropriate, follow-up care, and the diagnosis and management of complications.
• Collaboration with other health personnel, as appropriate.

7. All physicians and other health personnel should effectively evaluate and treat the pain of all patients in keeping with the patient’s values and preferences, including children, cognitively impaired patients, those unable to properly express themselves, and patients and populations historically undertreated for pain due to implicit or explicit biases.

8. Physicians and other health personnel should follow additional pain treatment guidance in the WMA Statement on the Responsibilities of Physicians in Preventing and Treating Opiate and Psychotropic Drug Abuse, the WMA Resolution on Drug Prescription, the WMA Declaration of Lisbon on the Rights of the Patient, and the WMA Declaration of Venice on End of Life Medical Care.

Governments, regulators and healthcare administrators

9. Governments, regulators and healthcare administrators should acknowledge the consequences of pain in terms of health, productivity, and economic burden.
10. Governments must ensure that patients in pain be given access to effective treatments, including the appropriate analgesic products. Unjustified barriers to such access are contrary to ethical principles and incompatible with respect for their right to health.

11. Governments should meaningfully engage patients, health professionals, and affected communities in the priority-setting, implementation, and evaluation of policies and regulations on controlled medicines, including assessing unintended real-world impacts on access and safety.

12. Governments should periodically review and revise drug control regulations and policies to ensure the availability and accessibility of controlled drugs such as opioids. In addition, appropriate efforts must be made to minimise misuse and illicit use, and governments should provide adequately resourced specialist support services for prescribed drug dependence. Relief of suffering and prevention against misuse should be balanced in the management of controlled drugs, while also ensuring that prescribing practices are guided by independent, evidence-based information and protected from undue influence. 

13. Governments, regulators and healthcare administrators in collaboration with professional groups and patients, should increase efforts to develop and implement evidence-based strategies and clear guidance to address restrictions on care, tapering and withdrawal management, overdose events and other harms experienced by patients with pain, mental illness or a substance use disorders.

14. Governments should provide sufficient resources for and support of research of pain prevention, education and treatment and identify and implement solutions, in particular:

• Explore factors that can impact access to pain treatment, such as financial condition, socioeconomic status, patient race and ethnicity, urban and rural differences, logistics, insufficient physician and health personnel education and training, and culture (misunderstandings about opioids or traditional pain management approaches, for example).
• Promote the use of validated pain assessment tools.
• Conduct or promote research on new pain relief treatments and methods of care, including non-pharmacological therapies.
• Establish a system and a standard procedure to record and collect pain-related data for correct statistics and monitoring. Pain-related data includes the incidence and prevalence of pain, cause of pain, pain treatment status, reason for improper treatment of pain, and number of people with drug abuse, etc. Particular emphasis must be placed on collecting adequate, standardised data to eliminate inequities for historically marginalised populations.
• Investigate context-specific drug diversion pathways (supply chain, prescribing, dispensing) and evaluate interventions that reduce diversion without restricting legitimate access.