by joe jamieson

Ghana Takoradi, Nepal Kathmandu, Nepal Pokhara, Philippines Dumaguete, Philippines Iloilo, Sri Lanka Kandy, Tanzania Arusha, Tanzania Dar es Salaam, Peru Arequipa, Clinical Features


Every year tens of millions of patients worldwide needlessly suffer debilitating pain without treatment. For many the pain is of such intensity that they would rather die than continue suffering.

Despite minimal costs for treatment, and the World Health Organisation prioritising palliative care as a global concern, developing countries are still denied access to vital pain medication.

State of pain treatment around the woerld

Who is denied pain treatment?

This map shows how terminal AIDS and cancer patients worldwide – conditions that cause unbearable pain – are denied essential treatment.

State of pain treatment around the woerld

Does everyone have the right to pain treatment?

According to international legislation by the UN, pain treatment is a human right.

  1. The International Covenant on Economic Social and Cultural Rights (ICESCR) asserts that governments must enable everyone to achieve:“[T]he highest attainable standard of physical and mental health.”

  2. The UN Committee on Economic, Social and Cultural Rights, the ICESCR’s monitoring body, holds that countries must provide patients with access to:“[F]unctioning public health and health-care facilities, goods and services, as well as programmes.”

  3. The committee also states that governments must provide certain core services, such as essential medicines, if they are to realise their obligation to fulfil their citizens’ right to health.

State of pain treatment around the woerld

Which countries can access pain treatment?

Based on Human Rights Watch data, access to strong pain medication remains severely limited in many of the world’s most populous countries.  This map shows the global discrepancy in pain treatment for patients in moderate to severe pain.

State of pain treatment around the woerld

Measuring pain intensity

Serious and life-threatening diseases are typically associated with moderate to severe pain:

Moderate - Pain disrupts daily activities. Patient can remain independent but must make lifestyle changes.
Severe - Debilitating pain. Patient cannot function independently or engage in normal activities.

Because of its duration – lasting for weeks, months or years – moderate to severe pain requires oral pain medication through opioids, rather than repeated injections. 

Oral opioids remain the best option for children and patients emaciated by terminal conditions such as cancer or HIV/AIDs.

What is preventing access to pain treatment?

According to Human Rights Watch, there are three key barriers to access:

State of pain treatment around the woerld


The lack of palliative care and training around the world

The World Health Organisation defines palliative care as:

 “…an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

However, governments often neglect palliative care, and it is the patients who suffer. As Laura Thomas, a health researcher at Human Rights Watch, states: Palliative care improves the quality of life for patients afflicted by serious and life-threatening illnesses through prevention and relief of suffering, particularly for afflictions where no cure can be expected


However, governments often neglect palliative care, and it is the patients who suffer. As Laura Thomas, a health researcher at Human Rights Watch, states:


State of pain treatment around the woerld


This map shows the integration and availability of palliative care for patients around the world:


State of pain treatment around the woerld


The war on drugs effect

The most common strong painkiller is morphine, which, like all similar painkillers, is an opioid: extracts of the poppy plant or similar synthetic derivatives.

All opioids are controlled substances, subject to strict anti-drugs legislation, which limits distribution and production.

However, these regulations have arguably become the biggest obstacles to patients receiving pain treatment around the globe.


State of pain treatment around the woerld


Catch 22

Many countries become trapped between the SCND and the INCB. Those nations that don’t report to the INCB are highly unlikely to receive legitimate exports of strong pain medicines from nations that do. In effect, both participating and not participating in the SCND and the INCB can deny countries access to pain treatment. One of the legacies of the war on drugs is the lack of access to pain medication for suffering patients worldwide.

Pain treatment is a fundamental human right. It’s morally imperative that governments and NGOs act to remove these barriers to access.


A number of charities and non-governmental organisations are working to address the inequity of pain treatment around the world, including:



You can read more about their efforts and how to get involved by visiting their websites.


Further reading

European Society of Medical Oncology – Global Opioid Policy Initiative

Harvard Global Equity Initiative – Lancet Commission on Global Access to Pain Control and Palliative Care

Human Rights Watch – Palliative Care: News

International Association for Hospice & Palliative Care – Resources

Pain & Policy Studies Group – PPSG News

Worldwide Hospice Palliative Care Alliance – Latest News

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