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United Nations Says Untreated Pain Is “Inhumane and Cruel”

Editor's Memo October 2017. Dr. Tennant draws attention to the way the UN, World Health Organization, and Human Rights Watch define severe, chronic pain, and challenges the US to do better.
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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.”1

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.

Chronic pain patients deserve access to opioid medications to manage their pain.

If Ever There Was a Need for a Call to Action, It Is Now

According to the Institute of Medicine (IOM), an estimated 100 million Americans suffer from pain—more than diabetes, heart disease, and cancer combined.2

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.3 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.3

All of the finger-pointing, blaming, and hand-wringing has escalated to a feverish pitch along with a lot of head-scratching. How about an earnest effort to come up with a viable solution? Clearly, a better approach is needed.

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”.4 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”4 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”.5

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.4 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.2,6

In addressing marginalized groups, the UN report offered the following:4

  • “People who use drugs are a highly stigmatized and criminalized population whose experience of healthcare is often one of humiliation, punishment, and cruelty.”
  • “Actions by healthcare workers and police often deprive individuals of their civil rights and access to medical care.”
  • “By denying effective drug treatment, State drug policies intentionally subject a large group of people to severe physical pain, suffering, and humiliation.”
  • “Persons with disabilities are particularly affected by forced medical interventions and continue to be exposed to non-consensual medical practices” (A/63/175, para 40).

In conclusion, the report states that: “The right to an adequate standard of health care (‘right to health’) determines the States’ obligations towards persons suffering from illness…In that fashion, attention to the torture framework ensures that system inadequacies, lack of resources or services will not justify ill-treatment.

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:4

“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.

Adopt policies and protocols that uphold autonomy, self-determination and human dignity. Ensure that information on health is fully available, acceptable, accessible and of good quality; and that it is imparted and comprehended by means of supportive and protective measures such as a wide range of community-based services and supports (A/64/272, para 93).”

To work against denial of pain relief, Juan E. Mendez recommended that all states:4

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