Global Need for Palliative Care and Pain Relief

Palliative care and pain relief services are needed in health systems worldwide in order to address the high levels of health-related suffering.

A new report, published in The Lancet, estimated the health-related suffering and the need for palliative care and pain relief on a global scale in order to quantify the burden of health-related suffering and develop strategies to expand access to palliative care and pain relief.

“Inequity in access to essential pain relief for palliative care and pain relief is one of the world’s most striking injustices. The world suffers a deplorable pain crisis: little to no access to morphine for tens of millions of adults and children in poor countries who live and die in horrendous and preventable pain,” said Professor Felicia Knaul, co-chair of the Commission from the University of Miami. “We cannot allow opiophobia to keep inexpensive, essential medicines from low-income patients in agony as they fight diseases such as cancer, HIV, or near end of life.”

The report analyzes 20 life-threatening and life-limiting health conditions—such as HIV, cancers, heart disease, injuries, and dementia—and 15 common symptoms, including pain, fatigue, wounds, anxiety, and depression. THe authors found that more than 61 million people need palliative care per year, and more than 80% of those people live in low and middle-income countries.

The authors explained palliative care should not act as a substitute for improved access to treatments and health interventions that could prevent the original suffering, rather the access to basic pain relief and palliative care should be available automatically within a health system. Additionally, the report found that Mexico meets only 36%, China meets 16%, India meets 4% and Nigeria meets 0.2% while some of the world’s poorest countries have virtually no palliative care access.

“One shouldn't have to live through an earthquake in Haiti, or be struck by a car, to understand the importance of trauma care,” added Professor Paul Farmer, co-chair of the Commission, Harvard Medical School. “Nor should it be necessary to be diagnosed with cancer to understand the importance of chemotherapy. All too often, however, we forget that access to life-saving medical care should always be accompanied by life-affirming palliative care.”

The report also noted that the Western European countries act as a benchmark for the appropriate access to opioid analgesics for palliative care, as the US levels exceed this benchmark—leading to the US opioid epidemic.

The authors ultimately recommend the need for governments to negotiate the prices of essential medication packages and the need for a balanced approach for global and national policies to maximize access of palliative care.