Editor’s Memo October 2017: United Nations Says Untreated Pain Is “Inhumane and Cruel” – Oct 2017 – Forrest Tenant
The national debate on the proper use of opioids continues to build as the high prevalence of addiction and overdoses fuel the continuing attention to this “public health crisis.”
Much of the anti-opioid rhetoric regarding the “opioid epidemic” implies that pain is a nuisance that really doesn’t require treatment.
Instead of making the focus one of achieving good pain relief, far too much attention has been directed solely at the risks of opioid prescribing and how we must provide naloxone on every street corner where an opioid might be sold.
What we need now is a proper discussion about the immense risks of untreated pain.
Simply put, untreated severe and chronic pain are not only forms of torture but put patients on the road to death.
We have known for ages that untreated moderate to severe pain, whether slowly or rapidly, may lead to hyperlipidemia, hypertension, tachycardia, adrenal exhaustion, cardiovascular collapse, and at times to suicide.
In the search for answers, I’d like to call immediate attention to the General Assembly of the United Nations (UN), which is on record as having declared that “untreated pain is tantamount to torture or cruel, inhuman or degrading treatment or punishment”.
If only our legislators and government agency leaders would read the “Report of the Special Rapporteur on Torture and Other Cruel Degrading Treatment or Punishment” before acting to diminish patients’ access to needed pain medicines.
Following the UN report, Human Rights Watch weighed in, stating that “the poor availability of pain treatment is both perplexing and inexcusable”
Given the urgent need for a reasonable and responsible approach to pain care, every pain practitioner and all pain patients should become familiar with these reports, which make a case for profound governmental failures; but that’s not enough.
The time has come to demand that every pain treatment critic in the United States government, the insurance industry, members of the press, religious leaders, and anyone else for that matter who is addressing this subject seek solutions that do more than tie the hands of credentialed medical professionals who are treating patients with chronic pain.
As well, there is a need to distinguish between addiction, abuse, and a medically confirmed need for opioid treatment in forming future programs.
Know the Facts Before Withholding Pain Care
The UN report laid out the reality of suffering with pain and presented recommendations that need more widespread dissemination.
In particular, people who use drugs are not necessarily addicts or substances abusers, as many are simply patients who developed a medical condition that has left them unable to function without adequate treatment for severe, chronic, or intractable pain
Although resource constraints may justify only partial fulfillment of some aspects of the right to health, a State cannot justify its non-compliance with core obligations, such as the absolute prohibition of torture, under any circumstances. (Committee on Economic, Social and Cultural Rights, general comment No. 14).”
Aiming to protect people with pain conditions, UN Special Rapporteur Juan E. Mendez recommended the following:
“Safeguard free and informed consent on an equal basis for all individuals without any exception, through a legal framework and judicial and administrative mechanisms, including through policies and practices to protect against abuses.
To work against denial of pain relief, Juan E. Mendez recommended that all states:
“Adopt a human rights-based approach to drug control as a matter of priority to prevent the continuing violations of rights stemming from the current approaches to curtailing supply and demand (A/65/255, para. 48).
Ensure that national drug control laws recognize the indispensable nature of narcotic and psychotropic drugs for the relief of pain and suffering; review national legislation and administrative procedures to guarantee adequate availability of those medicines for legitimate medical uses;
Ensure full access to palliative care and overcome current regulatory, educational and attitudinal obstacles that restrict availability to essential palliative care medications, especially oral morphine.
States should devise and implement policies that promote widespread understanding about the therapeutic usefulness of controlled substances and their rational use;
Develop and integrate palliative care into the public health system by including it in all national health plans and policies, curricula and training programmes and developing the necessary standards, guidelines, and clinical protocols.”
Inadequate Pain Care Is a Worldwide Concern
Eighty-three percent of the world population has either no or inadequate access to treatment for moderate to severe pain.
Thirty-two countries in Africa alone, for example, have almost no morphine available. In France, a study found that doctors underestimated pain in over half of their AIDS patients. In India, more than half of the country’s regional cancer centers do not have morphine or doctors trained in using it. This is despite the fact that 70% or more of their patients have advanced cancer and are likely to require pain treatment.
A Better Approach to Pain Is a US Imperative
It’s time that we openly acknowledge that we are in a most profound and serious battle over the most basic of human rights—the relief of pain and suffering. Let’s call it what it is. Many entities want to deprive patients who are suffering from moderate to severe pain their human right to adequate pain treatment.
These same opioid epidemic-defenders would not admit publicly or to themselves that by withholding access to all available pharmacotherapies, they are in effect promoting torture, cruelty, or degrading treatment.
In my opinion, the problem with our failed approach to pain care stems from a narrow view of pain that misses the point. Withholding all means of pain treatment goes against the view advocated by the UN, WHO, and Human Rights Watch.
It is past due for each and every one of us, including our pain patients and their families, to use our voices to tell all concerned parties that we support the UN view that untreated pain is tantamount to torture, and is cruel, inhuman, or degrading punishment. We need a more medically informed approach to treating people with severe, chronic, intractable pain.