Wednesday, July 27, 2011

Stop Torture in Health Care: Treat the Pain

StopTorture According to an increasingly vocal assembly of international health and human rights organizations, disparities in access to pain care worldwide are staggering. Instead of healthcare settings being places where human rights are preserved, they often are institutions where rights are abused and pain is mistreated or untreated to the point of being torture. While such problems might be smugly perceived as the plight of developing countries, even in the most modern societies, including the U.S., the epidemic of pain is a plague that can and should be humanely addressed and eradicated.

Cancer deaths are expected to double by 2030 and the World Health Organization estimates that each year there are 5.5-million terminal cancer patients suffering in pain in countries with low or no access to controlled medicines. Recent Pain-Topics UPDATES have noted failures in effectively treating the 20% of people worldwide with chronic pain [here] and even deplorable deficiencies in controlling acute postsurgical pain [here]. The recent U.S. Institute of Medicine report, noting that 116-million Americans suffer unrelieved chronic pain [see UPDATE here], highlights the extent and pervasiveness of the problems. Also in the U.S., between 70 and 90% of advanced cancer patients experience pain that could be better relieved via more effective analgesia.

Two important global movements are focusing on these issues: the Treat the Pain Campaign and the Campaign to Stop Torture in Health Care. Along with that, there is an ongoing series of brief videos — LIFE Before Death — that dramatize in documentary fashion the incredible extent of pain relief problems in most of the world and the associated suffering.

An underlying premise of these projects is that patients with pain are frequently at risk of experiencing severe physical and/or mental suffering instead of quality care. Their contact with health facilities and medical providers is too often characterized by physical abuse, insults, invasion of privacy, forced medical procedures, and/or denial of adequate treatment or any treatment at all. Several groups at special risk are from socially marginalized populations: persons living with HIV, those with life-limiting illnesses, people who abuse drugs, and individuals with intellectual disabilities or mental health problems.

The most severe abuses in healthcare, including the denial of essential pain relief medications, may rise to the level of ill-treatment and torture. In this context, torture is not intentionally inflicted but occurs when healthcare workers are prevented from adequately helping patients because of misconceived government policies or regulations, or because of bureaucratic inertia. In many parts of the world even basic morphine analgesia is unavailable or severely rationed.

Here is more information on the campaigns:

  • Treat the Pain — is a project of the Union for International Cancer Control (UICC) and the American Cancer Society's Global Access to Pain Relief Initiative (GAPRI) to advocate for high-quality pain treatment for all who need it worldwide, and to connect those who would like to join the fight with meaningful actions. The campaign uses the resources and voices of its members to promote and advocate for universal access to adequate pain relief.

    Founded in 1933, the UICC is the largest cancer-fighting organization of its kind, with more than 400 member groups across 120 countries. With headquarters in Geneva, Switzerland, it is a leading non-governmental, non-profit, non-political, and non-sectarian organization. More information about GAPRI and UICC can be found here:

  • The campaign to Stop Torture in Health Care — was created by the Open Society Public Health Program to help people assertively demand their human rights, including the right to relief of cancer and noncancer pain. The campaign promotes government accountability for all forms of ill-treatment, in many cases tantamount to torture, in health settings, including egregious and pervasive abuses condoned on the grounds of medical, public health, or social order necessity.

  • LIFE Before Death — is a poignant series of brief documentary videos focusing on the global crisis in untreated pain as part of the Treat the Pain campaign. Each week for 50 weeks a different video will be posted (as of this writing the first 10 are available). Topics include discussions of opiophobia, different types of pain, and the tragic, unnecessary suffering of patients around the world.

    These are must-see for all professionals and patients concerned with better pain care. They are likely to be an engrossing, emotional experience for most viewers, inciting anger and disdain for societies in which senseless suffering is so readily tolerated even though more adequate care could be feasible.

COMMENTARY: First, we would like to acknowledge and thank Holly Yang, MD, at [here] for bringing the video series to our attention. This, in turn, led to our discovery of the global advocacy organizations.

Second, as we also have noted in many prior UPDATES, the advocacy organizations point out that there are many potential dire consequences related to inadequately treated pain, including physiological, psychological, social, and economic. Patients with unrelieved pain may experience reduced mobility, loss of strength, disturbed sleep, immune impairment, and increased susceptibility to disease. They become depressed and anxious and cannot fully function or participate in society, or the workforce. These effects also increase codependence on caretakers and family members.

Third, a common theme of these organizations is that effective treatment is possible with opioid analgesics; at the least, morphine. Yet, a web of barriers prevents access for patients in need, including legal and regulatory restrictions, generally weak healthcare systems, and concerns about drug diversion and addiction. One of the LIFE Before Death videos notes, “One in every ten people alive today will die in severe pain because the cheap medicine they need is derived from opium, perhaps the most controversial and controlled substance on Earth.”

Fourth, while it is tempting to believe that access to pain care is only a problem of more primitive societies or underdeveloped countries, this is not the case. As most readers are aware, even in medically-advanced countries — US, Canada, UK, Australia, France, and a great many others — with a multitude of opioid-analgesic options available, there still are major issues of mistreated or untreated pain largely due to access barriers.

A fixation on the potential for prescription drug misuse and abuse, and biased or misinterpreted morbidity and mortality data relating to opioid analgesics, have fostered regulatory and legislative climates in many countries that subvert adequate pain care. Perhaps, a careful viewing of the LIFE Before Death series by opinion leaders, regulators, and lawmakers will inspire them to rethink the great harms they are doing to the vast majority of citizens for the sake of the relatively small minority who they believe need protecting from the alleged “evils” of opioids.

Meanwhile, what can you do today? Go to the “Do Something” page at Treat the Pain [here]… right now!