R-2011-01-2011_OVE
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Handbook of WMA Policies
World Medical Association R-2011-01-2011
WMA RESOLUTION
ON
THE ACCESS TO ADEQUATE PAIN TREATMENT
Adopted by the 62nd
WMA General Assembly, Montevideo, Uruguay, October 2011
PREAMBLE
Around the world, tens of millions of people with cancer and other diseases and conditions
experience moderate to severe pain without access to adequate treatment. These people
face severe suffering, often for months on end, and many eventually die in pain, which is
unnecessary and almost always preventable and treatable. People who may not be able to
adequately express their pain – such as children and people with intellectual disabilities or
with consciousness impairments – are especially at risk of receiving inadequate pain
treatment.
It is important to acknowledge the indirect consequences of inadequate pain treatment, such
as a negative economic impact, as well as the individual human suffering directly resulting
from untreated pain.
In most cases, pain can be stopped or relieved with inexpensive and relatively simple
treatment interventions, which can dramatically improve the quality of life for patients.
It is accepted that some pain is particularly difficult to treat and requires the application of
complex techniques by, for example, multidisciplinary teams. Sometimes, especially in
cases of severe chronic pain, psycho-emotional factors are even more important than
biological factors.
Lack of education for health professionals in the assessment and treatment of pain and other
symptoms, and unnecessarily restrictive government regulations (including limiting access
to opioid pain medications) are two major reasons for this treatment gap.
PRINCIPLES
The right to access to pain treatment for all people without discrimination, as laid down in
professional standards and guidelines and in international law, should be respected and
effectively implemented.
Physicians and other health care professionals have an ethical duty to offer proper clinical
assessments to patients with pain and to offer appropriate treatment, which may require
prescribing medications – including opioid analgesics – as medically indicated. This also
applies to children and other patients who cannot always adequately express their pain.
Instruction on pain management, including clinical training lectures and practical cases,
should be included in mandatory curricula and continuing education for physicians and
R-2011-01-2011 Montevideo
Adequate Pain Treatment
other health professionals. Such education should include evidence-based therapies
effective for pain, both pharmacological and non-pharmacological. Education about
opioid therapy for pain should include the benefits and risks of the therapy. Safety concerns
regarding opioid therapy should be emphasized to allow the use of adequate doses of
analgesia while mitigating detrimental effects of the therapy. Training should also include
recognition of pain in those who may not be able to adequately express their pain, including
children, and cognitively impaired and mentally challenged individuals.
Governments must ensure the adequate availability of controlled medicines, including
opioids, for the relief of pain and suffering. Governmental drug control agencies should
recognize severe and/or chronic pain as a serious and common health care issue and
appropriately balance the need to relieve suffering with the potential for the illegal use of
analgesic drugs. Under the right to health, people facing pain have a right to appropriate
pain management, including effective medications such as morphine. Denial of pain
treatment violates the right to health and may be medically unethical.
Many countries lack necessary economic, human and logistic resources to provide optimal
pain treatment to their population. The reasons for not providing adequate pain relief must
therefore be fully clarified and made public before accusations of violating the right to
health are made.
International and national drug control policies should balance the need for adequate
availability and accessibility of controlled medicines like morphine and other opioids for
the relief of pain and suffering with efforts to prevent the misuse of these controlled
substances. Countries should review their drug control policies and regulations to ensure
that they do not contain provisions that unnecessarily restrict the availability and
accessibility of controlled medicines for the treatment of pain. Where unnecessarily or
disproportionately restrictive policies exist, they should be revised to ensure the adequate
availability of controlled medicines.
Each government should provide the necessary resources for the development and
implementation of a national pain treatment plan, including a responsive monitoring
mechanism and process for receiving complaints when pain is inadequately treated.