WHO cancer pain relief programme.

Cancer pain relief is a ubiquitous but neglected public health problem. Every day more than three and a half million people suffer from cancer pain, but only a fraction receive treatment for it. Relatively simple and inexpensive methods of pain relief are available. Adequate pain relief is not reaching a great number of cancer patients in developed countries. In the developing countries, where more than half the world's cancer patients are and where most are incurable at the time of diagnosis, pain relief (often the only relevant human alternative) by and large is not offered. Obstacles to effective cancer pain relief worldwide include poor drug availability, misguided national drug legislation, lack of education of doctors and nurses, underprescribing and underdosing by the professionals, wrong timing of drugs given, fear of addiction and lack of public awareness that pain can be controlled. A World Health Organization (WHO) method has been developed which provides for drugs to be administered immediately if there is pain, to be given 'by the clock' rather than 'on demand' and to be increased from non-opioids (aspirin or paracetamol) to weak opioids (codeine) and then to strong opioids (morphine) until the patient is free from pain--hence the concept of a three-step ladder for cancer pain relief. Field tests have shown that the right drug in the right dose at the right time relieves 80 to 90% of pain. Thus a scientifically valid, relatively inexpensive method suitable for reaching patients at community level does exist.