Montreal Declaration: Access to pain therapy is a fundamental human right

Access to pain therapy is a fundamental human right

We, the delegates of the International Pain Summit ( IPS) of the International Association for the ( IASP, composed of IASP representatives from associations in 64 countries and members in 129 countries as well as members of the societies), have thoroughly examined the unrelieved pain in the world.

It must be noted that pain management is insufficient in most parts of the world because

• There is insufficient access to treatment for acute pain caused by injuries or illnesses, including end-of-life suffering. There is a lack of understanding that chronic pain is a serious chronic health problem requiring care structures analogous to other chronic diseases such as diabetes or chronic heart disease

• There are very large deficits in knowledge about pain mechanisms and pain treatment among healthcare professionals;

• Chronic pain, with or without a diagnosis, is highly stigmatized;

• Most countries either have no national policy strategy at all or only an inadequate approach to managing the health problem of pain, including an insufficient level of research, education, training and further education;

• Pain medicine is not recognized as a separate specialized field with specific, comprehensive knowledge and practical responsibilities, based on scientific research and interdisciplinary training;

• The World Health Organization (WHO) estimates that 5 billion people live in countries where there is no or insufficient access to opioid painkillers and who have no or insufficient access to treatment for moderate to severe pain;

• There are serious limitations in the availability of opioid painkillers and other essential medicines for the treatment of pain.

And in recognition of the inherent dignity of human beings and the profound injustice of withheld pain treatment, which leads to unnecessary suffering and is detrimental to health, we declare that the following human rights must be recognized worldwide:

Article 1: The right of all people to access pain treatment without discrimination. ^1-4

Article 2: The right of people in pain to recognition of their pain and to information about diagnostic and treatment methods. ⁵

Article 3: The right of all people in pain to access diagnostic and treatment methods provided by adequately trained and qualified healthcare personnel. ^6-8

To guarantee these rights, we acknowledge the following obligations:

1. Governments and all healthcare institutions have a responsibility, within the bounds of the law and with due consideration of available healthcare resources, to create laws, policies, and structures that help people in pain access adequate pain management, rather than hindering their access. Failure to implement such laws, policies, and structures is unethical and constitutes a violation of human rights.

2. All healthcare professionals involved in a patient's care have an obligation, within the bounds of the law and with due consideration of available resources, to offer a patient in pain the treatment that would be provided by a diligent and competent healthcare professional in that area of ​​care. Failure to provide such treatment is unethical and constitutes a violation of human rights.

Note : This declaration was prepared with due consideration of the current overall situations and forms of healthcare provision in both developed and developing countries. Nevertheless, it is the responsibility of governments, health authority staff at all levels, and healthcare professionals to adapt the implementation of the articles of this declaration as new pain management frameworks emerge.

Footnotes:

1. This includes, but is not limited to, discrimination based on age, biological and social sex, medical diagnosis, race or ethnicity, religion, culture, marital, civil or socioeconomic status, sexual orientation or political or other opinion.

2. International Covenant on Economic, Social and Cultural Rights (ICESCR) (1966). The ratifying states of the ICESCR recognize the “right to the highest attainable standard of physical and mental health” (Article 12) and, consequently, “the right to medical care for everyone”.

3. Universal Declaration of Human Rights (1948): Right to an adequate standard of living (Article 25); Convention on the Rights of the Child (Article 24); Convention on the Elimination of All Forms of Discrimination against Women (Article 12); Convention on the Elimination of All Forms of Racial Discrimination (Article 5(e)(iv)).

4. UN Committee on Economic, Social and Cultural Rights. Comment No. 14, 22nd Session, April-May 2000 E/C 12/2000/4. The “core commitment” of all ratifying states includes the obligation to provide access to health facilities, goods and services without discrimination, to make essential medicines, as defined by the World Health Organization, available, and to develop and implement a national health strategy.

5. UN Committee on Economic, Social and Cultural Rights. Commentary No. 14, 22nd Session, April-May 2000 E/C 12/2000/4, paragraph 12. Commentary No. 14 states that access to health “includes the right to request, receive and transmit information relating to health issues”.

6. Appropriate pain assessment includes documenting the assessment results (e.g., pain as the "fifth vitality parameter" can draw attention to unrelieved pain and lead to appropriate therapy modifications). Appropriate treatment includes access to pain medication, including opioids and other analgesics, as well as guideline-based, interdisciplinary, and integrative multimodal non-pharmacological treatment methods, with access to experts qualified in the safe and effective use of these medications and treatments, and supported by health policies, legal frameworks, and procedures that facilitate such access and prevent inappropriate interventions. Due to the shortage of adequately trained healthcare professionals, this means creating training and continuing education opportunities in pain diagnostics and therapy across all healthcare professions, as well as establishing social services programs for pain management. It also includes implementing programs for the initial, advanced, and continuing education of specialist physicians in pain medicine and palliative care. Continuing education catalogs are intended to ensure appropriate continuing education and treatment standards.

7. The denial of access to pain therapy violates the UN Single Convention on Narcotic Drugs (1961), which declares the medical benefit of narcotics in the relief of pain to be essential and provides for an adequate supply of narcotics for medical purposes.

8. The Universal Declaration of Human Rights (1948) (Article 5) states: “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.” Commentary: Deliberately ignoring the need for pain management or failing to seek specialized help when pain relief is inadequate may constitute a violation of Article 5.

9. The UN Special Rapporteur on the Right to Health and the UN Special Rapporteur on Torture stated: “The failure to provide access to controlled medicines to alleviate pain and suffering threatens fundamental human rights to health and to protection from cruel, inhuman or degrading treatment.”

Sources:

1. ANZCA. Statement on patients' rights to pain management. ANZCA PS 45; 2001. Available at: www.anzca.edu.au
2. Brennan F, Carr DB, Cousins ​​MJ. Pain management: a fundamental human right. Anesth Analg 2007;105:205–21.
3. Cousins ​​MJ, Brennan F, Carr DB. Pain relief: a universal human right. Pain 2004:112:1–4.
4. FEDELAT. Proclamation of pain treatment and the application of palliative care as human rights, May 22, 2008.
5. IAHPC. Joint declaration and statement of commitment on palliative care and pain treatment as human rights. Available at: www.hospicecare.com
6. Scholten W, Nygren-Krug H, Zucker HA. The World Health Organization paves the way for action to free people from the shackles of pain. Anesth Analg 2007; 105:1–4.
7. Somerville M. Death of pain: pain, suffering, and ethics. In Gebhart GF, Hammond DL, Jensen TS, editors. Proceedings of the 7th World Congress on Pain. Progress in Pain Research and Management, Vol. 2. Seattle: IASP Press; 1994. p. 41-58.

Approved by the General Assembly of the
International Association for the Study
of Pain (IASP Council) on October 28, 2010

Translation: Prof. Hartmut Göbel, Kiel Pain Clinic

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See here for a list of all organizations and individuals who support the declaration.