WHO reviews its recommended strategies on pain control

FURTHER to concerns raised last year, the director-general of the World Health Organisation (WHO), Dr Tedros Adhanom Ghebreyesus, has ordered a review of two published guidance documents on pain control.

“The WHO takes very seriously concerns recently raised about the development of its 2011 guideline, ensuring balance in national policies on controlled substances: guidance for availability and accessibility of controlled medicines, as well as its 2012 guidelines on the pharmacological treatment of persisting pain in children with medical illnesses.

“The WHO is discontinuing these guidelines in light of new scientific evidence that has emerged since the time of their publication. This will also address any issues of conflicts of interest of the experts that have been raised,” the organisation said.

The WHO said it remained fully committed to ensuring that people suffering from severe pain had access to effective pain-relief medication, including opioids, and noted that the organisation was concerned about the low level of access to medication for moderate and severe pain, particularly among people in low- and middle-income groups.

“The WHO also recognises that the need for access to pain relief must be balanced with concerns about the harm arising from the misuse of medications prescribed for the management of pain, including opioids,” it said.

“Scientific evidence indicates there are risks associated with the use of these medications – such as the development of dependence, overdose and accidental death.

“Even when prescribed according to established clinical guidelines and patients’ needs, and used as directed, certain factors may increase these risks,” WHO said.

While potential harm could be reduced through enforcement of proper regulation on controlled medicines, careful initial assessment of patients prior to prescribing them, and regular patient-monitoring and patient-education, were required. The differences between acute and chronic pain needed to be understood, and they needed to be managed accordingly.

“Recent research in the fields of palliative care and pain management has identified many strategies for managing pain, beyond drug treatment alone. Evaluating this new evidence and establishing best strategies for alleviating pain – both acute and chronic – is an important area of work for the WHO.”

In this regard, the WHO already initiated a process for reviewing and updating its guidelines and policy documents regarding pain management. Further work to produce guidance for the management of pain in different age groups was ongoing, including a review of guidance given for children.

Information on the revision process can be found on WHO’s website, at https://www.who. int/news-room/detail/27-08-2019-who-revisionofpain-management-guidelines

“The WHO remains committed to working with member states to support the development of evidence-based policies, regulations and best practices to promote access to safe, effective and affordable medicines for the management of pain, and to prevent their misuse and harm,” the organisation said.

“We are discontinuing these guidelines in light of new evidence World Health Organisation