Is access to pain relieving drugs a law enforcement or moral problem — or is it a basic human right?

There is a growing international consensus in favor of the latter, according to a special article in the July 1007 issue of Anesthesia & Analgesia, the official publication of the International Anesthesia Research Society.

According to co-author Dr. Frank Brennan of Calvary Hospital in Kogarah, Australia, "Medicine is at an inflection point, at which a coherent international consensus is emerging: the unreasonable failure to treat pain is poor medicine, unethical practice, and is an abrogation of a fundamental right."

Under treatment of pain is a serious problem around the world, related to cultural, societal, religious, and political factors. Poorly controlled pain has serious adverse effects, both physical and psychological, as well as "massive social and economic costs to society," Dr. Brennan and coauthors write. Cancer pain is a special concern — up to 70 percent of cancer patients experience severe pain caused by their disease or its treatment.

Inadequate management of pain from cancer and other causes is caused by "opiophobia and opioignorance" — fear and ignorance of morphine and related drugs. For physicians, lack of training in the proper use of opioids is compounded by highly publicized cases in which doctors have been prosecuted for prescribing the drugs.

The authors outline the reasons for the general delay in recognizing the importance of pain management. Although pain relief is clearly a core value of medical ethics, the legal foundation for a right to pain management is somewhat dubious. In response, some governments, including Australia and the state of California, have passed laws explicitly defining a right to adequate pain management and protecting doctors who treat pain in terminally ill patients.

As pain is an international problem, the World Health Organization (WHO), as the U.N.'s supreme health agency, is likely to play a critical role in any solution. Building on previous successes in the areas of cancer pain relief and palliative care, the WHO is spearheading efforts toward increasing the availability of medical opioids and making them more affordable.

Dr. Brennan and colleagues call on the U.N. to declare an International Year of Pain Management, and on WHO and other international bodies to create a single organization to focus on the area of pain control. "Much work and continuing vigilance will be required to make the transition from asserting that pain management is a fundamental human right, to a future in which appropriate pain management is a global reality," the authors conclude.