Approaches to the problem of untreated pain

More than 3.2 billion people worldwide lack access to adequate pain relief even though morphine, the most effective treatment for severe pain, is safe, effective, plentiful, inexpensive, and easy-to-use.

Legal and regulatory restrictions, cultural misperceptions about pain, inadequate training of healthcare providers, a poorly functioning market, generally weak health systems, and concern about diversion, addiction, and abuse create a web of barriers that force millions of people to live and die with treatable pain.

Access to pain treatment is particularly limited in low and middle-income countries where approximately 70% of cancer deaths and 99% of HIV deaths in the world occur, but just 7% of the opioid analgesics are consumed.

The problem can be addressed through several approaches, including a human rights focus, a policy focus, and a training focus.

Our preferred approach: mechanism of access

We prefer to address the problem using a mechanism of access approach. Together with our partners, we've identified an 8-step framework to group challenges and interventions, called the Morphine Framework. It's a little hard to read here, so you can download a more detailed description of the framework here, or look at our recent article in Lancet Oncology, which describes the framework.

Morphine framework

Mapping the mechanism of access

When we first start working in a country, we map out the steps to access, as shown in the following figure for Nigeria.

Morphine process



Finding the problems

We then interview doctors, nurses, patients, and government officials to determine where challenges block movement along the path to access.

Morphine challenges



Finding the solutions

Then we look for solutions to these challenges. This becomes the basis of our strategic plan.

Morphine solution

Developing a strategy

Here is an example of the strategic plan developed for Nigeria.


Nigeria strategy