Chronic pain: Is it a human rights issue?

States, nations addressing research, access to care

Chronic pain has gathered increasing international attention as a human rights issue, and a bipartisan bill introduced in Congress in July seeks to mandate the right of chronic pain sufferers to education, treatment, and research into the condition.

"Medicine is at an inflection point, at which a coherent international consensus is emerging: The unreasonable failure to treat pain is poor medicine, unethical practice, and is an abrogation of a fundamental right," according to Frank Brennan, MBBS, DCH, a palliative care specialist in Sydney, Australia.1 Brennan and colleagues write in the July issue of Anesthesia & Analgesia on the medical, legal, and ethical reasons for declaring access to pain management a global human right.

The National Pain Care Policy Act of 2007, introduced by U.S. Rep. Mike Rogers (R-MI) and Rep. Lois Capps (D-CA), addresses chronic pain issues on a national level by proposing research, grants for education and training, and public awareness.

"Pain is the leading cause of disability in the United States, and is straining our health care system," says Capps, a registered nurse. "This legislation takes several important steps to improve the assessment, understanding, and treatment of pain. Hopefully, this will provide much needed relief for many people suffering from pain."

The bill would authorize the Institute of Medicine to conduct a special conference on pain care; establish permanent authorization for a pain consortium at the National Institutes of Health; set up a grant program for pain care education and training; and direct the Department of Health and Human Services to develop and implement a pain management public awareness pain.

"For many cancer patients, fear of cancer pain is worse than fear of death itself," according to Daniel E. Smith, president of the American Cancer Society Cancer Action Network. "The good news is that nearly all cancer pain can be relieved if treated adequately."

Pain carries 'massive costs'

Brennan and his colleagues assert that inadequate pain treatment is an entrenched problem around the world, related to cultural, societal, religious, and political factors — including the acceptance of torture. Poorly controlled pain has potentially serious adverse effects, both physical and psychological, as well as "massive social and economic costs to society." Cancer pain, Brennan states, is a special concern, with up to 70% of cancer patients experiencing severe pain caused by their disease or its treatment.

Ignorance and fear — specifically, "opiophobia" and "opioignorance" — contribute to the inadequacy of pain management, Brennan writes, because physicians are untrained and uncertain when it comes to effective use of opioids. He suggests that lack of training in proper use of morphine and other opioids is compounded by the occasional, highly publicized prosecution of physicians for opioid prescribing.

Some nations and states — including Australia and California — have passed laws defining a right to adequate pain management, protecting medical practitioners who treat pain in terminally ill patients, or introducing requirements for pain management and education.

For the second year, the American Cancer Society, the Lance Armstrong Foundation, and Susan G. Komen for the Cure released a "report card" on states' pain management policies. The report was issued in July and is available at www.painpolicy.wisc.edu.

The 2007 report card shows that California and Wisconsin had the greatest grade improvement. Other states whose grades improved from last year were Arizona, Colorado, Connecticut, Kansas, Massachusetts, and New Hampshire. Improvements were most often in removing legal restrictions that challenged pain management, or implementing state medical board pain management policy statements. Kansas, Wisconsin, Michigan, and Virginia are deemed to have the most balanced pain policies in the nation.

Reference

  1. Brennan F, Carr DB, Cousins M. Pain management: A fundamental human right. Anesth Analg 2007; 105:205–221.