February 23, 2010

Human Rights Watch researchers have interviewed thousands of victims of torture. But it may come as a surprise for a lot of people that our interviews with people experiencing severe, chronic pain are very similar to those who have been tortured.

Severe pain undermines quality of life. Pain is known to affect sleep, appetite and social interaction, and to cause anxiety. A World Health Organization study found that people who live with pain are four times as likely as others to suffer from depression.

Like torture victims, patients in severe pain told us that all they had wanted was for the pain to stop. Many torture victims do or say anything they think might stop the torture. Patients with untreated pain told us that they had contemplated suicide, told friends and relatives that they wanted to die, and prayed for death.

A Human Rights Watch report on access to pain treatment includes an advertisement from a Colombian newspaper that read: "Cancer is killing us. Pain is killing me because for several days I have been unable to find injectable morphine in any place. Please Mr. Secretary of Health, do not make us suffer any more."

As this advertisement attests, this suffering that so many endure is treatable, and treating it is also almost entirely in the hands of governments. Morphine is a restricted drug, and governments must estimate the amount they need and request it from the International Narcotics Control Board - the UN agency assigned the task of controlling licit opiod production and distribution.

In a recently published article in BMC Medicine, "Access to Pain Treatment as a Human Right," three researchers from Human Rights Watch discuss barriers to effective pain treatment. These include problems with procurement and distribution systems for pain medications, the need for adequate government policies to address the issue, poor instruction for healthcare workers, complex drug control regulations, fear of legal penalties among healthcare professionals, and the cost of medications.

But what is really shocking in the article is the estimates some countries give for their annual morphine needs.

Burkina Faso estimates that 8 people need morphine per year. Gabon estimates 14. The Gambia, 31.

Those lucky few.

Even when the estimates are larger, they still represent a shockingly small percentage of those in pain.

Kenya, for example, estimates that close to 5,000 people will need morphine. But that represents only 4 percent of the 115,000 people expected to experience severe pain from cancer or HIV/AIDS. The calculations don't even consider those who experience acute pain or chronic pain from other causes.

The Human Rights Watch report, "Unbearable Pain: India's Obligation to Ensure Palliative Care," took an in-depth look at palliative care and access to pain medicines in India. The report found that even though more than 70 percent of patients in India's major cancer care hospitals were incurable and likely to require pain treatment, the hospitals did not provide patients with morphine. Some simply did not have morphine, and some had doctors and nurses who were not trained to prescribe it. India has invested in advanced cancer treatment centers providing state-of-the art treatment. But for the large majority of cancer patients who arrive for diagnosis late and seek only medicine to address their pain, cheap, effective morphine, produced in India, is not available.

More needs to be done to help the tens of millions of people worldwide experiencing untreated severe pain. I wish I could say that the solution was simple. In one sense it is: morphine is cheap and it is effective. In another it is not: political commitment is needed to help those suffering, and to overcome the regulatory barriers and lack of training of health providers worldwide.

One patient told us: "I just kept crying...with that pain you think death is the only solution." We need to ensure that better solutions are available.

More reporting on: