Declaration of Montreal of the International Association for the Study of Pain (IASP)
Declaration that Access to Pain Management Is a Fundamental Human Right
2011 Dec;152(12):2673-4. doi:10.1016/j.pain.2011.09.012. Epub 2011 Oct 11. PubMed PMID: 21995880

The Montreal Declaration is a milestone in addressing inadequate pain treatment worldwide. It is a key document for joint initiatives by scientists, doctors, health politicians, health insurance companies and other institutions to enable access to pain therapy as a fundamental human right. Access to pain management without discrimination is an indicator of contemporary health systems and societies that address the needs of affected, suffering people with pain caused by injury or illness, including suffering at the end of life. The declaration is made available here for the first time in cooperation with the IASP in German.

Montreal Declaration

Access to pain therapy is a basic human right

We, the representatives of the International Pain Summit ( IPS ) of the International Association for the Study of Pain ( IASP , composed of IASP representatives from associations in 64 countries and members in 129 countries as well as members of Societies) have delved deeply into the unrelieved pain in the world.

It is noted that pain management is inadequate in most parts of the world because

  • There is inadequate access to treatment of acute pain caused by injury or illness, including end-of-life suffering. There is a lack of understanding that chronic pain represents a serious chronic health problem that requires care structures analogous to other chronic diseases such as diabetes or chronic heart disease;
  • there are very large deficits among healthcare professionals in the knowledge of pain mechanisms and pain treatment;
  • chronic pain, with or without a diagnosis, is highly stigmatized;
  • Most countries either have no national policy strategy at all or have an inadequate approach to managing the health problem of pain, including inadequate levels of research, education, training and education;
  • Pain medicine is not recognized as a separate specialized subject with specific, comprehensive knowledge and practical scope, which is based on scientific research and interdisciplinary training;
  • the World Health Organization (WHO) estimates that 5 billion people live in countries with no or inadequate access to opioid painkillers and no or inadequate 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 recognizing the dignity inherent in human nature and the profound injustice of withholding 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 have access to pain treatment without discrimination. 1-4

Article 2: The right of people in pain to have their pain recognized and to be informed about methods of diagnosis and treatment. 5

Article 3: The right of all people with pain to have access to diagnostic and treatment methods by adequately trained, advanced and advanced health professionals. 6-8

To ensure these rights, we recognize the following obligations:

  1. The obligation of governments and all healthcare institutions, within legal means and with due regard to available healthcare resources, to create laws, policies and structures that help, not hinder, access to adequate pain management for people in pain. Failure to implement such laws, policies and structures is unethical and constitutes a breach of human rights.
  1. The obligation of all healthcare professionals who are in a treatment relationship with a patient, within the legal possibilities and with due consideration of the available treatment resources, to offer a patient with pain the treatment that is offered by a carefully and competently working healthcare professional in this area of ​​care would be. Failure to provide such treatment is unethical and a violation of human rights.

Note : This Declaration has been prepared with due regard to the current overall situations and forms of health care in developed and developing countries.
However, it is the responsibility of governments, health authorities at all levels and health professionals to adapt the implementation of the articles of this Declaration as new pain therapeutic conditions arise.


  1. This includes, but is not limited to, discrimination based on age, biological and gender, medical diagnosis, race or ethnicity, religion, culture, marital, civil or socioeconomic status, sexual orientation or political or other opinion.
  1. International Covenant on Economic, Social and Cultural Rights (ICESCR) (1966). The ratifying states of the ICESCR recognize the “right to the highest attainable physical and mental health” (Article 12) and, consequently, “the right to medical care for everyone”.
  1. 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)).
  1. 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 enable access to health structures, goods and services without discrimination, to make essential medicines available as defined by the World Health Organization and to develop and implement a national health strategy.
  1. UN Committee on Economic, Social and Cultural Rights. Comment No. 14, 22nd session, April-May 2000 E/C 12/2000/4, paragraph 12. Comment No. 14 states that health access “the right to request, receive and provide information relating to health issues “including transmitting”.
  1. Adequate pain assessment includes documentation of the assessment results (e.g. pain as the “5th vitality parameter” can draw attention to unrelieved pain and lead to appropriate therapy modification). Appropriate treatment includes access to pain medications, including opioids and other analgesics, as well as guideline-adherent, 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 policy, legal framework and procedures that enable such access and avoid inappropriate measures. Due to the lack of adequately trained health professionals, this means creating education and training opportunities in pain diagnosis and therapy across all health professions, as well as creating social service programs for pain management. Also included is the implementation of programs for the training, further education and training of doctors specializing in pain medicine and palliative medicine. Further training catalogs are intended to ensure appropriate further training and treatment standards.
  1. The denial of access to pain therapy violates the UN Convention on Narcotic Drugs (1961), which declares the medical benefits of narcotics in the relief of pain to be essential and requires an adequate supply of narcotics for medical purposes.
  1. The Universal Declaration of Human Rights (1948) (Article 5) states: “No person shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.” Comment: Deliberately ignoring the need for pain therapy or failing to seek specialized care when pain relief is inadequate to do so may constitute a violation of Article 5.
  1. The UN Special Rapporteur on the right to health and the UN Special Rapporteur on torture stated: “Failure to provide access to controlled medicines to relieve pain and suffering threatens fundamental human rights to health and to protection from cruel, inhuman or degrading treatment.”



  1. ANZCA. Statement on patients' rights to pain management. ANZCA PS 45; 2001. Available at:
  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:
  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 Council of the
International Society for the Study
of Pain (IASP Council) on October 28, 2010

Translation: Prof. Hartmut Göbel, Kiel Pain Clinic

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View the list of all organizations and people supporting the Declaration here.