Global Pain Initiatives

2015: WHO - National policies on controlled substances

Ensuring balance in national policies on controlled substances

Guidance for availability and accessibility of controlled medicines

The WHO Policy Guidelines for Controlled Substances provide guidance on policies and legislation with regards to availability, accessibility, affordability and control of medicines made from substances regulated under the international drug control conventions, herein referred to as “controlled medicines”. Their scope encompasses “all controlled medicines”, but with a specific focus on essential medicines. Controlled medicines play an important role in several areas of medicine, including pain treatment, treatment of opioid dependence, emergency obstetrics, psychiatry and neurology. The availability, accessibility and affordability of controlled medicines are important issues for all countries, but problematic for most of them.

This book elaborates on the background and then provides 21 guidelines on various topics: content of drug control legislation and policy; authorities and their role in the system; policy planning for availability and accessibility; healthcare professionals; estimates and statistics; procurement; and nationally listed drugs. Each guideline has an elucidation and a description of the legal context. The Country Assessment Checklist enables the user to determine which guidelines still need to be worked on. A CD-ROM provides additional information.

Target audience: policy-makers, regulators (in government, administrative departments, national competent authorities) and politicians; academia and civil society; healthcare professionals and their organizations; individuals (including patients and their families) and organizations whose area of work or interest is drug control or public health.

The guidelines are endorsed by the International Narcotics Control Board. Endorsement by the United Nations Office on Drugs and Crime has been requested.

More information on the WHO website.

Oct 2011: WMA Resolution on Pain Treatment

WMA Resolution on the Access to Adequate Pain Treatment

Adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011  


Around the world, tens of millions of people with cancer and other diseases and conditions experience moderate to severe pain without access to adequate treatment. These people face severe suffering, often for months on end, and many eventually die in pain, which is unnecessary and almost always preventable and treatable. People who may not be able to adequately express their pain - such as children and people with intellectual disabilities or with consciousness impairments - are especially at risk of receiving inadequate pain treatment.

It is important to acknowledge the indirect consequences of inadequate pain treatment, such as a negative economic impact, as well as the individual human suffering directly resulting from untreated pain.

In most cases, pain can be stopped or relieved with inexpensive and relatively simple treatment interventions, which can dramatically improve the quality of life for patients.

It is accepted that some pain is particularly difficult to treat and requires the application of complex techniques by, for example, multidisciplinary teams. Sometimes, especially in cases of severe chronic pain, psycho-emotional factors are even more important than biological factors.

Lack of education for health professionals in the assessment and treatment of pain and other symptoms, and unnecessarily restrictive government regulations (including limiting access to opioid pain medications) are two major reasons for this treatment gap.

ICD 11: Chronic pain to be included

Following the latest publication in Pain, it is suggested to include a classification of chronic pain in the upcoming 11th revision of the International Classification of Diseases ICD. This suggestion is already reflected in the ß-version of ICD 11 which is currently out for testing and commenting until August 2016. The objective is to decide on a final version during the World Health Assembly meeting in May 2017.

Although being preliminary and potentially subject to changes, this constitutes a major step forward to

  • achieve greater attention to chronic pain as a global health priority and adequate pain treatment
  • enable acquisition of epidemiological data related to chronic pain
  • form a basis for adequate billing for health care expenses related to pain treatment
  • support the development and implementation of new therapies.

Here you can find the full Pain article on the ICD 11 classification of chronic pain.