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From the *Department of Palliative Care, Calvary Hospital, Kogarah, NSW Australia; Departments of Anesthesiology and Medicine, Tufts-New England Medical Center, Boston, Massachusetts; Javelin Pharmaceuticals, Inc., Cambridge, Massachusetts; Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, St. Leonards, NSW Australia.
Address correspondence and reprint requests to Michael Cousins, MD, DSc, Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, St. Leonards, NSW Australia. Address e-mail to mcousins{at}nsccahs.health.nsw.gov.au.
Abstract
This article surveys worldwide medical, ethical, and legal trends and initiatives related to the concept of pain management as a human right. This concept recently gained momentum with the 2004 European Federation of International Association for the Study of Pain (IASP) Chapters-, International Association for the Study of Pain- and World Health Organization-sponsored "Global Day Against Pain," where it was adopted as a central theme. We survey the scope of the problem of unrelieved pain in three areas, acute pain, chronic noncancer pain, and cancer pain, and outline the adverse physical and psychological effects and social and economic costs of untreated pain. Reasons for deficiencies in pain management include cultural, societal, religious, and political attitudes, including acceptance of torture. The biomedical model of disease, focused on pathophysiology rather than quality of life, reinforces entrenched attitudes that marginalize pain management as a priority. Strategies currently applied for improvement include framing pain management as an ethical issue; promoting pain management as a legal right, providing constitutional guarantees and statutory regulations that span negligence law, criminal law, and elder abuse; defining pain management as a fundamental human right, categorizing failure to provide pain management as professional misconduct, and issuing guidelines and standards of practice by professional bodies. The role of the World Health Organization is discussed, particularly with respect to opioid availability for pain management. We conclude that, because pain management is the subject of many initiatives within the disciplines of medicine, ethics and law, we are at an "inflection point" in which unreasonable failure to treat pain is viewed worldwide as poor medicine, unethical practice, and an abrogation of a fundamental human right.
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