SAN ANSELMO, California – The World Health Organization’s (WHO) Executive Board adopted a resolution on January 23, encouraging countries to prioritize universal access to pain medications and palliative care for those with life-threatening diseases.
Over 6.5 million people die while suffering from pain — moderate to severe, due to cancer, AIDS and other conditions — globally every year without access to pain medications. About 40 million need palliative care for pain relief.
In fact, 90% of those suffering from painful symptoms associated with life-threatening diseases, primarily in the developing world, do not have access to pain-relieving treatments.
Palliative care, according to the WHO, is a holistic style of care meant to decrease suffering and improve the state of being of those living with life-threatening conditions. Such care would include the alleviation of psychosocial, physical and spiritual pain while a person is dying or seeking treatment for a potentially fatal illness.
Roughly one-third of those who need palliative care have cancer, while, on the other hand, sufferers of chronic diseases such as HIV/AIDS and heart disease are increasingly being recognized as benefiting from pain alleviating treatments.
A report by the WHO and the Worldwide Palliative Care Alliance shows only 20 nations have health systems that strongly integrate palliative care. The report explains that the need for palliative care is comparable with many other humanitarian crises since so many people are suffering unnecessarily without access to resources that could provide relief.
Moderate to severe pain, the report states, could be alleviated by cheap generic drugs like morphine, but for a variety of reasons, physicians tend to be hesitant to utilize this resource.
Meg O’Brien, director of the Global Access to Pain Relief Initiative, states, “There isn’t a single government that couldn’t procure morphine if they wanted it. But no one is demanding it.”
In the New England Journal of Medicine, Daniela Lamas and Lisa Rosenbaum, both doctors, explain the disconnect between patient needs and lack of pain-relieving care.
They write, “Physicians’ perceptions about palliation are at the root of the problem. Many physicians seem to believe that to discuss pain control is to admit defeat…Even in the United States, whose palliative care movement has been under way for decades, many physicians were surprised when researchers showed that treating pain does not hasten death but, rather, prolongs survival.”
The strict international regulation of illegal drugs also affects the ability of physicians to prescribe and comfort with prescribing opioids such as morphine to patients.
Dr. Lamas and Dr. Rosenbaum explain that drug trafficking is a recognizable and well-known crime, but that those dying in pain are “generally invisible.”
They assert, “International legislation focuses primarily on erecting barriers to illegal trafficking of heroin, rather than on removing the barriers that make its therapeutic counterpart, morphine, unavailable.”
In fact, doctors in some countries can face penalties for prescribing morphine. Even if doctors have the ability to give patients morphine, the process can be so regulated as to be virtually impossible to navigate.
Many doctors also fear patients will become dependent on the drugs. Dr. M.R. Rajagopal, a palliative care doctor in India, asserts that more needs to be done in India and around the world to educate physicians about the importance of palliative care.
He recounts a story of a patient who had been prescribed morphine to help him cope with the pain of nasopharyngeal cancer. Upon seeing the prescription slip, another doctor ripped it up and warned him to not take the medicine because it would “destroy him.”
Lack of access to palliative care, however, can also be destructive. Human Rights Watch’s research in nations such as India, Mexico, Kenya, Ukraine and Senegal reveal that people living with high levels of pain from life-threatening diseases can attempt suicide and other self-harming acts.
With an again-global population and the increased prevalence of chronic illnesses such as heart disease and dementia, demand for palliative care is expected to increase.
The WHO urges governments to integrate palliative care into their national health priorities and healthcare systems as a sustainable way of alleviating pain for millions and of reducing preventable emergency care. They also state that medical professionals should receive better training in regards to patient pain management, and that pain medicines must become more widely available to patients who suffer greatly without them.
– Kaylie Cordingley
Sources: New England Journal of Medicine, The Guardian, Human Rights Watch
Photo: NCD Alliance