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Access to Pain Management: Declaration of Montreal

Declaration of Montreal

Declaration that Access to Pain Management Is a Fundamental Human Right

We, as delegates to the International Pain Summit (IPS) of the International Association for the Study of Pain (IASP) (comprising IASP representatives from Chapters in 64 countries plus members in 130 countries, as well as members of the community), have given in-depth attention to the unrelieved pain in the world,

Finding that pain management is inadequate in most of the world because:

  • There is inadequate access to treatment for acute pain caused by trauma, disease, and terminal illness and failure to recognize that chronic pain is a serious chronic health problem requiring access to management akin to other chronic diseases such as diabetes or chronic heart disease.
  • There are major deficits in knowledge of health care professionals regarding the mechanisms and management of pain.
  • Chronic pain with or without diagnosis is highly stigmatized.
  • Most countries have no national policy at all or very inadequate policies regarding the management of pain as a health problem, including an inadequate level of research and education.
  • Pain Medicine is not recognized as a distinct specialty with a unique body of knowledge and defined scope of practice founded on research and comprehensive training programs.
  • The World Health Organization (WHO) estimates that 5 billion people live in countries with low or no access to controlled medicines and have no or insufficient access to treatment for moderate to severe pain.
  • There are severe restrictions on the availability of opioids and other essential medications, critical to the management of pain.

 

And, recognizing the intrinsic dignity of all persons and that withholding of pain treatment is profoundly wrong, leading to unnecessary suffering which is harmful; we declare that the following human rights must be recognized throughout the world:

Article 1. The right of all people to have access to pain management without discrimination (Footnotes 1-4).

Article 2. The right of people in pain to acknowledgment of their pain and to be informed about how it can be assessed and managed (Footnote 5).

Article 3. The right of all people with pain to have access to appropriate assessment and treatment of the pain by adequately trained health care professionals (Footnotes 6-8).

In order to assure these rights, we recognize the following obligations:

 

  1. The obligation of governments and all health care institutions, within the scope of the legal limits of their authority and taking into account the health care resources reasonably available, to establish laws, policies, and systems that will help to promote, and will certainly not inhibit, the access of people in pain to fully adequate pain management. Failure to establish such laws, policies, and systems is unethical and a breach of the human rights of people harmed as a result.
  2. The obligation of all health care professionals in a treatment relationship with a patient, within the scope of the legal limits of their professional practice and taking into account the treatment resources reasonably available, to offer to a patient in pain the management that would be offered by a reasonably careful and competent health care professional in that field of practice. Failure to offer such management is a breach of the patient's human rights.

Note: This Declaration has been prepared having due regard to current general circumstances and modes of health care delivery in the developed and developing world. Nevertheless, it is the responsibility of: governments, of those involved at every level of health care administration, and of health professionals to update the modes of implementation of the Articles of this Declaration as new frameworks for pain management are developed.

Signatories of the Declaration of Montreal

For Organizations

The Declaration of Montréal, a document developed during the First International Pain Summit on September 3, 2010, states that access to pain management is a fundamental human right.

The Declaration is endorsed by IASP and the International Pain Summit Steering Committee.

Note: Only presidents, CEOs, executive directors, or others who can legally act as representatives may sign on behalf of an organization.

The following organizations have endorsed the Declaration.

PSIBE Institute Argentina
Armenian Organization For The Study Of Pain Armenia
Order Of Chaos Australia
Hunter Pain Clinic Australia
Chronic Pain Australia Australia
AIDS Projects Management Group Australia
International Association Of Pain And Chemical Dependency Australia
Internarnational Assoctiation For The Study Of Pain Australia
Scenar Therapist Association Australasia Inc. Australia
Australian And New Zealand Society Of Palliative Medicine Australia
Australian Pain Society Australia
Palliative Care Research Team, Monash University Australia
Australian Pain Management Association Inc Australia
Toowomba Pain Management Australia
Australian Pain Management Association Inc. Australia
Bangladesh Society For Study Of Pain Bangladesh
Pain Alliance Europe Belgium
Belgian Pain Society (National IASP Chapter) Belgium
Asociacion Boliviana Del Dolor Bolivia
Assotiation For Pain Therapy In Bosnia And Herzegovina (APTBH) Bosnia And Herzegovina
Comissão De Portadores De Fibromialgia Brazil
Brazilian Society Of Temporomandibular Disorders And Orofacial Pain (SBDOF) Brazil
Wilderman Medical Clinic Canada
MUHC Canada
Pain Warriors Canada
HRM Chronic Pain Support Group Canada
Canadian Institute For The Relief Of Pain And Disability Canada
Huron County Narcotic Pain Medication Support Group & Adcovacy Canada
Canadian Association Of Occupational Therapists Canada
Canadian Academy Of Pain Management Canada
East End Multidisciplinary Pain Management Program Canada
Canadian Pain Coalition Canada
Alberta Occupational Therapy Pain Association Canada
Society Of Alberta Occupational Therapists Canada
Canadian Pain Coalition Canada
AQDC Canada
Arachnoiditis Canada Canada
The Chronic Pain Association Of Canada Canada
The Refugee Forum, University Of Ottawa Canada
Pain Science Division Of CPA Canada
Canadian Pain Society Canada
Sjogren's Syndrome Association Inc. Canada
Wellbeings Canada
IASP Chapter Chile Asociacion Chilena Para Estudio Del Dolor Chile
Hong Kong Pain Society China
IASP China Chapter China
Iglesia Anglicana Del Caribe Y Nueva Granada Colombia
Ulacit Dental School Costa Rica
Czech Pain Society (CPS) Czech Republic
Danish Pain & Physiotherapy Association Denmark
Minia University & National Cancer Institute Egypt
Pain Clinic Grenoble Hospital France
Schmerzzentrum Hockenheim Germany
Zies Ggmbh Germany
German Pain Society (Deutsche Gesellschaft Zum Studium Des Schmerzes) Germany
Arbeitsgemeinschaft Schmerztherapeutischer Einrichtungen In Bayern Germany
Deutsche Gesellschaft Zum Studium Des Schmerzes E.V. (Dgss) Germany
International Society For Music In Medicine ISMM Germany
Meenakshi Mission Hospital & Research Centre India
Socio Academic And Palliative Care Foundation India
Guwahati Pain And Palliative Care Society India
Emmanuel Hospital Association India
Samraksha India
Pallium India India
Karunashraya Bangalore Hospice Trust India
Achieve Hospital Iran
Iraqi Society For Pain Management Iraq
Azienda Ospedaliera Della Valtellina E Valchiavenna, Struttura Di Cure Palliative E Ambulatorio Di Terapia Del Dolore Italy
Cardarelli Italy
Jordan Pain Society Jordan
Kenya Hospices And Palliative Care Association (Kehpca) Kenya
Ongata Ngong Palliatiave Care Community Based Organization Kenya
Professional Health Association Kosovo
School Of Dentistry, Lebanese University Lebanon
Lithuanian Pain Society Lithuania
Malaysian Association For The Study Of Pain Malaysia
Mexican Asociation For The Study And Mnagement Of Pain Mexico
Asociacion Mexicana Para El Estudio Y Tratamiento Del Dolor Mexico
Algos Mexico
Asociación Mexicana Para El Estudio Y Tratamiento Del Dolor Ac Mexico
Faculty Of Pain Medicine, Australian & New Zealand College Of Anaesthetists New Zealand
Plus Rehab Physiotherapy New Zealand
Federal Medical Centre Owerri Nigeria
Centre For Palliative Care Nigeria
Pain And Palliative Medicine Dept. Federal Medical Centre Abeokuta Nigeria
The Kidney Centre Karachi Pakistan
Society For Treatment & Study Of Pain (STSP) Pakistan
Esperantra Peru
ASPED Peru
Philippine Society Of Anesthesiologists, Inc. Philippines
Pain Society Of The Philippines Philippines
Polskie Towarzystwo Badania Bólu - Polish Chapter Of IASP Poland
Sociedade Portuguesa De Hidrologia Médica Portugal
Programa Regional De Controlo Da Dor Na Região Autónoma Dos Açores Portugal
Associação Portuguesa Para O Estudo Da Dor - Aped Portugal
Asociacion Dominicana Para El Estudio Tratamiento Del Dolor Y Cuidados Paliativos Republic of Dominica
Professional Health Association Republic Of Kosovo
Moldovan Society For The Study And Management Of Pain Republic Of Moldova
Algesiology Association Of Romania Romania
Epymedica Romania
Serbian Association Of Pain Research And Treatment Serbia
Hospice In The West South Africa
Tapologo Hiv And Aids Programme South Africa
Hospice Palliative Care Association Of South Africa South Africa
PAINSA South Africa
Sociedad Española De Dolor Spain
Andalusian Health Service Spain
Sociedad Castellano Manchega Del Dolor Spain
Dutch Pain Society The Netherlands
Hospice Africa Uganda
African Palliative Care Association Uganda
Palliative Care Association Of Uganda Uganda
Hospice Africa Uganda Uganda
Department Of Neurology And Child Neurology At The Kharkiv Medical Academy Of Postgraduate Education Ukraine
NGO Legal Analitics And Strategies Institute Ukraine
The Walton Centre United Kingdom
Midlands Pain Management Ltd. United Kingdom
Thyroid UK United Kingdom
International Alliance Of Patients' Organizations United Kingdom
York & District Pain Management Support Group United Kingdom
Access Matters United Kingdom
Cairdeas International Palliative Care Trust United Kingdom
The British Pain Society United Kingdom
Intlife Pain United Kingdom
Betsi Cadwaladr University Health Board - West United Kingdom
Foundation For Pain Medicine USA
American Academy Of Pain Medicine USA
American Pain Foundation USA
Arizona Physical Therapy Specialists USA
Stanford University USA
Freedom Fighters Corporation USA
Power Of Pain Foundation USA
Capital Hospice USA
International Association For Hospice And Palliative Care (IAHPC) USA
University Of California - San Francisco USA
Living In Pain.Org Inc. USA
Pain Connection-Chronic Pain Outreach Center, Inc. USA
American Chronic Pain Assocation USA
Pain & Policy Studies Group USA
Life With Arachnoiditis USA
The Chronic Pain Educational Documentary Series USA
Stress Resources Llc USA
Pain Treatment Topics (Pain-Topics.Org) USA
Arizona Pain Initiative USA
American Board Of Pain Medicine USA
California Academy Of Pain Medicine USA

*Note: Only presidents, CEOs, executive directors, or others who can legally act as representatives may sign on behalf of an organization.

Last updated: September 15, 2015

For Individuals

The Declaration of Montréal, a document developed during the First International Pain Summit on September 3, 2010, states that access to pain management is a fundamental human right.

Latest version for the Individuals was updated September 2015

Footnotes

Footnotes

  1. This includes, but is not limited to, discrimination on the basis of age, sex, gender, medical diagnosis, race or ethnicity, religion, culture, marital, civil or socioeconomic status, sexual orientation, and political or other opinion.
  2. International Covenant on Economic, Social and Cultural Rights (ICESCR) (1966). The State parties of the ICESCR recognize "the right of everyone to the highest attainable standard of physical and mental health" (Art. 12), creating the "conditions which would assure to all medical service and medical attention in the event of sickness."
  3. Universal Declaration of Human Rights (1948): Rights to Health (Article 25); Convention on the Rights of a Child (Article 24); Convention on the Elimination of All Forms of Discrimination Against Women (Article 12); Convention on the Elimination of All Forms of Racial Discrimination (Article 5(e) (iv)).
  4. The Committee on Economic, Social and Cultural Rights. General Comment No.14, 22nd Session, April-May 2000 E/C 12/2000/4. "Core obligations" of all signatory nations included an obligation to ensure access to health facilities, goods, and services without discrimination, to provide essential drugs as defined by WHO, and to adopt and implement a national health strategy.
  5. Committee on Economic, Social and Cultural Rights. General Comment No.14, 22nd Session, April-May 2000, E/C 12/2000/4, para. 12. General Comment No. 14 stated that health accessibility "includes the right to seek, receive and impart information and ideas concerning health issues."
  6. Appropriate assessment includes recording the results of assessment (e.g., pain as the "5th vital sign," can focus attention on unrelieved pain, triggering appropriate treatment interventions and adjustments). Appropriate treatment includes access to pain medications, including opioids and other essential medications for pain, and best-practice interdisciplinary and integrative nonpharmacological therapies, with access to professionals skilled in the safe and effective use of these medicines and treatments and supported by health policies, legal frameworks, and procedures to assure such access and prevent inappropriate use. Given the lack of adequately trained health professionals, this will require providing educational programs regarding pain assessment and treatment in all of the health care professions and programs within the community for community care workers delivering pain care. It also includes establishment of programs in pain medicine for the education of specialist physicians in pain medicine and palliative medicine. Accreditation policies to assure appropriate standards of training and care should also be established.
  7. Failure to provide access to pain management violates the United Nations 1961 Single Convention on Narcotic Drugs declaring the medical use of narcotic drugs indispensable for the relief of pain and mandating adequate provision of narcotic drugs for medical use.
  8. The UN Universal Declaration of Human Rights (1948) (Article 5) states: "No one shall be subjected to torture or to cruel, inhuman or degrading treatment…" Comment: Deliberately ignoring a patient's need for pain management or failing to call for specialized help if unable to achieve pain relief may represent a violation of Article 5.
  9. The UN Special Rapporteur on the Right to Health and the UN Special Rapporteur on the question of torture and other cruel, inhuman, and degrading treatment stated: "The failure to ensure access to controlled medicines for the relief of pain and suffering threatens fundamental rights to health and to protection against cruel, inhuman and degrading treatment."

References

  • ANZCA. Statement on patients' rights to pain management. ANZCA PS 45; 2001. Available at: www.anzca.edu.au.
  • Brennan F, Carr DB, Cousins MJ. Pain management: a fundamental human right. Anesth Analg 2007;105:205-21.
  • Cousins MJ, Brennan F, Carr DB. Pain relief: a universal human right. Pain 2004:112:1-4.
  • FEDELAT. Proclamation of pain treatment and the application of palliative care as human rights, May 22, 2008.
  • IAHPC. Joint declaration and statement of commitment on palliative care and pain treatment as human rights. Available at: www.hospicecare.com.
  • Scholten W, Nygren-Krug H, Zucker HA. The World Health Organization paves the way for action to free people from the shackles of pain. Anesth Analg 2007;105:1-4.
  • Somerville M. Death of pain: pain, suffering, and ethics. In Gebhart GF, Hammond DL, Jensen TS, editors. Proceedings of the 7th World Congress on Pain. Progress in Pain Research and Management, Vol. 2. Seattle: IASP Press; 1994. p. 41-58.