Global State of Pain

Human Rights Watch has just issued a new report, Global State of Pain Treatment, evaluating the state of palliative care worldwide. The report is a survey of palliative care experts in 40 countries, and maps the barriers impeding effective use of palliative care. The findings are not good.

Palliative care, the term used to describe administering drugs and other measures to bring comfort to those suffering from a painful illness (ie, palliative care is not used to treat a disease, only to ameliorate pain), is a common measure for cancer care and other illnesses. As is widely known, advanced cancer often reaches a point where it simply is not treatable. When that’s the case, pain-relieving medicines—opioids such as morphine, most commonly—are given so that a person does not need to be in agony while they die.

So many of us have watched people suffer through this experience. I stood by my stepmother’s hospital bedside during her final hours, incredibly grateful for the morphine drip that was relieving her of otherwise excruciating pain during her last moments on earth. Forget about the question of whether or not everyone should be guaranteed access to drugs simply because they exist; that millions of people are dying while in pain when there are medications that could prevent is a thought that should give us all pain.

The full 128-page report is available online. Some of what it says:

• The World Health Organization estimates that “each year tens of millions of people suffer untreated moderate to severe pain, including 5.5 million terminal cancer patients and 1 million patients in the last phases of HIV/AIDS.”

• “…experts estimate that 60 percent of those who die each year in the developing world—a staggering 33 million people—need palliative care.”

• 14 countries among those surveyed reported no use of opioid pain medicines between 2006 and 2008

• More than 3.5 million terminal cancer and HIV/AIDS patients die each year without access to pain treatment

• Some of the barriers include: no national palliative care policy, lack of medical education on pain management, restrictive regulation on morphine (not required by international drug conventions), requiring special licenses for prescribing morphine, forbidding nurses from administering morphine (only 3 of 40 countries surveyed allow this), fear of legal sanctions for prescribing opioids, unnecessarily high cost of pain medication

The report also covers improvements on the horizon, in countries including Columbia, Jordan, Romania, and others, where palliative care reforms are underway.

Much more is included in the full report. Several maps show the availability of pain medications in different regions of the world, with color-coded levels of access: Green represents good availability, orange is limited, and dark red is severe shortage. Can you guess what color the map of sub-Saharan Africa is?

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