The document discusses several new global initiatives focused on improving access to pain treatment and palliative care. These include declarations by the IASP and WMA establishing pain relief as a human right. HRW reports document human rights issues related to lack of access to pain medication in India, Kenya, and Ukraine. The WHO and other organizations are working to integrate palliative care into health systems and improve availability of opioid medications. Global advocacy groups are also campaigning for better policies and access to treatment for cancer and other patients suffering from pain.

1. International Initiatives in
Cancer Pain
Kathleen M. Foley, MD
April 24, 2012

2. New Global Initiatives in Pain and
Palliative Care
• IASP Montreal Declaration on pain relief as a
fundamental human right
• A World Medical Association Declaration on access
to pain relief
• Human Rights Watch reports on access to pain
relief and palliative care
-India
-Kenya
-Ukraine

3. New Global Initiatives in Pain
Palliative Care
• World Medical Association calls for pain
and palliative care services within the
right to health framework and supports
their integration as human rights issues
http://www.wma.ne

4. New Global Initiatives in Pain and
Palliative Care
• Four Human Rights Watch Country
Reports describe the human rights abuses
related to lack of access to pain relieving
drugs in:
India
Kenya
Ukraine
http://www.hrw.org/

5. “Please , do not make us suffer
anymore…….”
Access to Pain Treatment as a Human Right
In this 47-page report Human Rights Watch said that countries could significantly
improve access to pain medications by addressing the causes of their poor availability.
These often include the failure to put in place functioning supply and distribution
systems; absence of government policies to ensure their availability; insufficient
instruction for healthcare workers; excessively strict drug-control regulations; and fear
of legal sanctions among healthcare workers.
http://www.hrw.org/en/reports/2009/03/02/please-do-not-make-us-suffer-any-more

6. http://www.hrw.org/sites/default/files/reports/health1009webwcover.pdf

7. http://www.hrw.org/features/kenya-government-failure-provide-palliative-care-children

8. Uncontrolled Pain
Ukraine’s Obligation to Ensure Evidence-
Based Palliative Care
http://www.hrw.org/reports/2011/05/12/uncontrolled-pain

9. People with debilitating 50 Milligrams is Not Enough
illnesses are left to die in
excruciating pain as a
result of restrictions on
pain medicines. Health
care workers must be
allowed to provide
patients with relief from
severe pain
Vlad is suffering from incurable brain cancer. Despite his chronic pain,
doctors in Ukraine are only allowed to prescribe 50 mg of pain medicine.
In another country, doctors would typically prescribe more than 2,000
mg for a patient like Vlad.
http://www.stoptortureinhealthcare.org/

10. New Global Initiatives in Pain and
Palliative Care
• The International Association of Hospice and
Palliative Care has:
• Developed an essential drug list for palliative
care medications
• Consists of 34 medications, 14 currently on
the WHO Essential Drug List
http://iahpcnews.com/

11. New Global Initiatives in Pain
and Palliative Care
• WHO Essential Drug Program has created an
office for addressing Access to Controlled
Substances as essential medicines
• Appointed Willem Scholten as program director
• Has developed a strategic plan with NGO
partnerships including the ATOME project

12. WHO Access to Essential Medicines
Program for Controlled Substances
• To improve access for opioid drugs in low and
medium resource countries
• Published two recent documents:
• “Guidelines for Persistent Pain in Children”
“Ensuring Balance in National Policies on
Controlled Substances”

13. New Global Initiatives in Pain and
Palliative Care
• UN General Assembly Meeting on Non-
Communicable Diseases:
• Calls for the integration of pain and
palliative care into health care services

14. New Global Initiatives in Pain and
Palliative Care
• New WHO Collaborating Centers in Palliative Care
have been recognized:
Barcelona, Spain
Kerala, India and Trivandrum, India
Kings’ College, London
Sir Michael Sobell House, Oxford
Pain and Policy Studies Program, the University
of Wisconsin,USA

15. New Global Initiatives in Palliative
Care
• Lien Foundation: Life Before Death initiative
www. lifebeforedeath.com
• TREAT THE PAIN Campaign
http://www.treatthepain.com/
• OSF Campaign: Stop Torture in Healthcare
http://stoptortureinhealthcare.org/

16. Global Access to Pain Relief
Initiative (GAPRI)
• Supported by International Union Against
Cancer (UICC)
-global advocacy initiative
-raise awareness for policy change
-focus on cancer patients
(http://www.uicc.org)

17. GAPRI Strategy
Intl policy
Suppliers GAPRI Pain Treatment
GAPRI Supplier Advocacy Project
Network
Multi-country global
health programs
GAPRI Envoy National policies and programs
Program
GAPRI
Facilities Fellowship
Program

18. New Global Initiatives in Pain and
Palliative Care
• OSF IPCI Leadership Development Initiative:
supports 44 leaders in palliative care from resource
limited countries to develop skills and knowledge to
advance pain and palliative care globally
• International Pain and Policy Fellows: 15 healthcare
professionals learn drug policy expertise to
improve access to palliative care medicines in
resource limited countries

19. Education in Palliative and End-of-Life Care
in Oncology (EPEC-O)
EPEC-O Content:
 Whole Patient Assessment 13 Symptoms, including
 Communicating Effectively  Pain
 Goals of Care  Nausea / vomiting
 Constipation
 Withholding withdrawing
 Bowel obstruction
 Clinical Trials
 Dyspnea
 Last Hours of Living
 Anorexia / cachexia
 Loss, Bereavement  Menopausal symptoms
 Survivorship  Pleural effusions
 Ascites
 Wounds
The EPEC Project of Northwestern University's Feinberg School of Medicine was created with the support of the American
Medical Association and the Robert Wood Johnson Foundation, with continued support from the National Cancer Institute
(R25 CA100754). The EPEC-O curriculum is produced by the EPEC Project with major funding provided by the National
Cancer Institute, with supplemental funding provided by the Lance Armstrong Foundation.

20. New Global Initiatives in Pain
and Palliative Care
End of Life Nursing Education
Program - ELNEC - educates
nurses globally in pain and
palliative care
Has detailed curriculum with
translations into 15 languages
(http://www.aacn.nche.edu/elnec)

21. International Palliative Care Resource Center
URL Will Be www.IPCRC.net