Pain & Pain-Medicine Decisions

Skip anything

Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Doctor or nurse who manages pain medicines: Options, benefits and side effects, and changes to the plan.
• Pain or palliative care specialist: Complex pain, where such a service exists.
• Pharmacist: Questions about medicines, side effects and supply.
• Physiotherapist: Movement, positioning and non-drug approaches.
• Psychologist: Coping with pain, sleep and worry.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A purposive sample chosen for contrast, not a ranking or a representative survey: Global, Ethiopia, India, Brazil, United Arab Emirates, Vietnam, United Kingdom, United States, Australia. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

• Global · Guidance · 2018

  WHO's 2018 guidelines on cancer pain in adults and adolescents state that the goal of pain management is to reduce pain to a level that allows a quality of life acceptable to the patient.

  What others could learn: A pain conversation can ask what level of pain would let the person live in a way they find acceptable, rather than assume the target is zero. The same chapter says individuals experience and express pain differently, and that care plans should allow for spiritual counseling appropriate to the beliefs of the patient and family.

  Conditions, limits and source

  Conditions that matter:

  Needs assessment and regular reassessment, analgesics including opioids that are available and affordable, and teams able to offer psychosocial care. The same chapter names regulatory and legal, attitude and knowledge, and economic and procurement barriers to pain relief.

  Cannot be inferred:

  Does not define an acceptable level of pain for any person. Does not show how often care plans reflect the patient's own goal. Says nothing about services in any particular country.

  Limits:

  A guiding principle, not a graded recommendation and not an evaluation of any service. The guideline covers medicines and radiotherapy; it does not describe how a person's acceptable level of pain is asked about or recorded. IRIS dates the item 2018-12-31.

  Source: World Health Organization, WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents (Chapter 5 'Cancer pain management: guiding principles', principle 5.1, printed p. 21 (PDF p. 23); principles 5.2 (individuals experience and express pain differently), 5.4 (psychosocial and spiritual care) and 5.5 (access) follow on printed pp. 21 and 22). Where: Global. Population: Adults and adolescents with pain from cancer. Published 2018-12-31; retrieved 2026-10-11.

• Global · Measured outcome · 2025

  WHO's 2025 guideline on controlled medicines policy cites a 2018 estimate that the shortfall in pain medication was under 2% of need in high-income countries and 98% in low-income countries.

  What others could learn: Whether a person can choose opioid pain relief at all depends on whether it is stocked where they live. The guideline says people who need controlled medicines, their families and their communities should be involved in consultation on national medicines policy.

  Conditions, limits and source

  Conditions that matter:

  Access depends on accurate national estimates of need reported to the International Narcotics Control Board, procurement, supply chains with full geographic coverage, trained prescribers, and laws that support medical access while restricting harmful non-medical use.

  Cannot be inferred:

  Does not give values for any named country. Does not show whether the shortfall has narrowed since 2018. Does not show what any person would choose if pain medication were available.

  Limits:

  A secondary citation: the guideline cites the estimate from reference 25, which was not fetched or checked. The estimate dates from 2018 and is modeled, not a count of people. It describes country income groups, not named countries, and says nothing about quality of care. The 2011 WHO guidance this replaces was withdrawn in 2019 and is not used here.

  Source: World Health Organization, WHO guideline on balanced national controlled medicines policies to ensure medical access and safety (Chapter 1 'Introduction', printed p. 3 (PDF p. 25); the preceding sentence gives the 2018 estimate that 59.4% of global need for pain medication was unmet. Section 1.2 (printed p. 5, PDF p. 27) says the guideline replaces 2011 guidance withdrawn in 2019. Section 4.3 (printed p. 21, PDF p. 43) covers consultation). Where: Global. Population: People who need pain medication to avert serious health-related suffering, worldwide. Published 2025-07-23; retrieved 2026-10-11.

• Ethiopia · Reported experience · 2023

  In a 2018 mixed-methods study in one Ethiopian region, the authors report that people are expected not to complain about pain, and that health professionals often invoked history and culture to discourage patients who wanted to discuss it.

  What others could learn: A person who says little about pain may be following a cultural expectation, not feeling little pain. Making it acceptable to speak about pain, and not dismissing it, comes before any treatment decision.

  Conditions, limits and source

  Conditions that matter:

  Only doctors could prescribe morphine, and morphine was absent from rural health care. Domestic morphine production depended on imported ingredients and foreign currency. Health workers' knowledge about opioids was limited.

  Cannot be inferred:

  Does not show how widely this expectation is held in Ethiopia or how it changes any individual's pain reports. Does not measure pain or treatment outcomes. Not representative of other regions.

  Limits:

  One region; the authors say findings may not generalize to other regions and that the recent war may have changed health services since data collection in 2018. The passage is the authors' summary of interviews, most of them with health workers, not a direct patient quote. Interviews were translated into English by the study team.

  Source: Palliative Medicine Reports (Aregay A, O'Connor M, Stow J, Ayers N, Lee S); full text via PubMed Central, Perceptions of Barriers to Using Opioid Analgesics: A Mixed Methods Study (Results, paragraph on cultural values and community narratives about pain (PMC full text); the abstract Results list 'expressing pain considered as a sign of weakness' and lack of foreign currency to import morphine ingredients (Palliat Med Rep 2023;4(1):249-256)). Where: Ethiopia (one of 11 regional states). Population: 38 interview participants from educational facilities, health services and the community; 220 nurses invited to a survey; focus groups with rural community members. Published 2023-08-30; retrieved 2026-10-11.

• India · Policy · 2018

  A 2018 review in a WHO South-East Asia journal says India's Narcotic Drugs and Psychotropic Substances Act of 1985, as first written, set harsh custodial sentences for minor clerical errors in hospitals stocking opioids. It was amended in 2014.

  What others could learn: When a person says pain medicine is hard to get, the cause may be law and paperwork far from the bedside. The same abstract says decades of civil society efforts led to a 2014 amendment to improve medical access, though implementation remained highly protracted.

  Conditions, limits and source

  Conditions that matter:

  Access depends on how drug control law treats hospitals that stock opioids, on implementation of the 2014 amendment, and on trained prescribers and palliative care services.

  Cannot be inferred:

  Does not show current law or current practice in Indian hospitals. Does not show how many people went without pain relief because of the Act. Does not describe implementation in any Indian state.

  Limits:

  Abstract only; the journal host and doi.org were unreachable, and the text of the Act was not fetched or checked. Authors include palliative care advocates and a WHO regional staff member. Describes the 1985 Act as first written; the abstract says it was amended in 2014. Published 2018, so later implementation is not covered.

  Source: WHO South-East Asia Journal of Public Health (Vallath N, Rajagopal MR, Perera S, Khan F, Paudel BD, Tisocki K); abstract via PubMed, Access to pain relief and essential opioids in the WHO South-East Asia Region: challenges in implementing drug reforms (Abstract (WHO South East Asia J Public Health 2018;7(2):67-72)). Where: India. Population: People with serious health-related suffering from pain in India and the WHO South-East Asia Region. Published 2018-09; retrieved 2026-10-11.

• Brazil · Service in operation · 2026

  A 2026 commentary reports that Brazil's health regulator, Anvisa, implemented a national digital prescription control system in 2024 for medicines subject to special control.

  What others could learn: Paperwork rules can decide whether a person in a small town can get strong pain medicine at all. For strong opioids on paper, prescribers must request special forms from a state or municipal health surveillance authority, a requirement the authors say may be a significant barrier in smaller towns.

  Conditions, limits and source

  Conditions that matter:

  Prescribers need prior registration and platforms integrated with SNCR. The authors report that in December 2025 Anvisa approved adding potent opioids and benzodiazepines to SNCR, and that paper prescriptions remain in use.

  Cannot be inferred:

  Does not show that e-prescribing has improved access to pain relief, reduced harm or reached remote communities. Does not report patients' views. Findings the commentary cites from studies elsewhere may not apply in Brazil.

  Limits:

  A two-author commentary, not an evaluation; the authors expect e-prescribing to ease access but report no access data since 2024. Resolution RDC 873/2024 and the December 2025 decision were not fetched or checked. PubMed indexes no abstract; the passage comes from the PMC full text.

  Source: Cadernos de Saúde Pública (Barros GAM, Simões CM); full text via PubMed Central, Anvisa authorization for electronic prescriptions of controlled substances: implications for equity in access to pain management in Brazil (Section 'Development', paragraph 1 (PMC full text; Cad Saude Publica 2026;42:e00266325); the paper-form requirements are under 'Equity in access to pain management'; the December 2025 extension to potent opioids is in 'Development', paragraph 3). Where: Brazil. Population: People in Brazil who need opioid analgesics or other medicines under special control, and their prescribers. Published 2026-05-01; retrieved 2026-10-11.

• United Arab Emirates · Reported experience · 2026

  In a 2024 interview study at one Abu Dhabi cancer institute, patients and family caregivers were generally satisfied with symptom relief, yet some reported fears of hallucinations, dizziness and possible overmedication.

  What others could learn: Satisfaction with pain relief and fear of side effects can sit together in the same family. One caregiver feared the team was giving too much; another was reassured that hallucinations and dizziness were temporary. Participants also asked for explanations in Arabic, so the language of reassurance matters.

  Conditions, limits and source

  Conditions that matter:

  Insurance covered palliative care for most participants. Analgesia was easier to obtain in hospital than outside it, where regulatory restrictions and pharmacy access caused delays. Participants asked for staff or translators who speak Arabic.

  Cannot be inferred:

  Does not show how common these fears are among patients or families in the UAE. Does not show whether reassurance changed decisions or pain relief. Does not describe services outside this institute.

  Limits:

  Small sample (10) at a single center; the authors note limited generalizability. Interviews were short and recorded by field notes, at participants' preference, not audio. The passage is the authors' discussion, not a participant quote.

  Source: Frontiers in Oncology (AlOlama KM, Alameri SO, Wissi Y, et al.); full text via PubMed Central, Cancer patients' insights and experience of palliative and supportive care in the UAE: a qualitative study (Discussion, paragraph 3 (PMC full text; Front Oncol 2026;16:1829844); Results Theme 2 'Balancing pain relief and medication concerns' gives the participant quotes; Theme 5 covers requests for explanation in Arabic). Where: United Arab Emirates (Abu Dhabi). Population: 10 participants: adults with cancer and family caregivers. Published 2026-05-14; retrieved 2026-10-11.

• Vietnam · Reported experience · 2025

  In interviews with 17 health care providers, regulators, and patients or caregivers across Vietnam, patient-related barriers to opioid access for cancer pain included fear of addiction and side effects and morphine's association with impending death.

  What others could learn: A person may hear 'morphine' as a sign that death is near. Asking what the word means to the person and family before discussing pain medicine can bring that fear into the open. The study's suggested solutions include education for patients and communities.

  Conditions, limits and source

  Conditions that matter:

  Participants described limited oral morphine availability, few manufacturers and suppliers, strict enforcement of regulations, difficulty obtaining certifications of continued need, and scarce palliative and home care services.

  Cannot be inferred:

  Does not show how many people in Vietnam hold these fears or how the fears affect pain relief. Does not assess whether opioids affect survival. Does not show that the suggested solutions work.

  Limits:

  Abstract only; the publisher host and doi.org were unreachable. Only six of 17 participants were patients or caregivers, and the abstract does not separate their views from those of providers and regulators. Barriers are named themes, not measured frequencies. Small sample.

  Source: JCO Global Oncology (Nguyen T, Dam A, Bui L, Pham T, Krakauer EL, Phelan C); abstract via PubMed, I Wait for Leftover Morphine: A Qualitative Study of Barriers to Safe Opioid Access for Cancer Pain Relief in Vietnam (Abstract, Results (JCO Glob Oncol 2025;11:e2500026)). Where: Vietnam. Population: Five health care providers, six patients with cancer or caregivers, and six regulators (n=17). Published 2025-06-04; retrieved 2026-10-11.

• United Kingdom · Measured outcome · 2025

  In a UK survey of 76 patients known to specialist palliative care, using hypothetical scenarios, 40.79% would accept high sedation from pain medicine, and 40.79% said a longer prognosis might change their answers, typically toward less sedation.

  What others could learn: Preferences about drowsiness versus pain relief vary between people and may shift with prognosis, so they can be asked about directly and revisited. Most respondents (89.47%) would be quite or very likely to accept mild sedation.

  Conditions, limits and source

  Conditions that matter:

  Needs time in consultations to explore preferences before sedation occurs; the authors note that physician-patient dialogue does not routinely include this.

  Cannot be inferred:

  Does not show what patients chose in practice, or their outcomes. Not representative of palliative care patients in the UK. Does not establish which level of sedation is right for anyone.

  Limits:

  Abstract only; the publisher host and doi.org were unreachable. Small sample. Answers are to hypothetical scenarios, not choices made during real treatment. The abstract does not state recruitment sites, diagnoses or response rate.

  Source: BMJ Supportive & Palliative Care (Burdon J, Fingas S, Parry R, Pitsillides C, Taylor P); abstract via PubMed, Sedation from analgesics: patient preference survey (Abstract, Results (BMJ Support Palliat Care 2025;15(2):262-265)). Where: United Kingdom (author affiliations in Nottinghamshire, Sheffield and Wirral, England; recruitment sites not stated in the abstract). Population: Patients known to specialist palliative care services (n=76). Published 2025-02-26 (online 2024-02-22); retrieved 2026-10-11.

• United States · Reported experience · 2026

  From focus groups with 15 Korean American immigrants living with chronic pain, the authors conclude that norms of endurance and emotional restraint may shape pain reporting, and language mismatches may affect communication with clinicians.

  What others could learn: A person may describe pain vaguely, or delay seeking help, because enduring pain is valued, not because the pain is mild. Participants also used non-drug strategies, including physical activity, dietary control, community resources and emotional self-regulation, which a pain plan can ask about and build on.

  Conditions, limits and source

  Conditions that matter:

  Participants reported difficulty describing pain in English, worry about medical bills, and transport barriers. The authors suggest narrative-based assessment alongside numeric scales and culturally tailored education; these are proposals, not tested.

  Cannot be inferred:

  Does not describe all Korean Americans or Asian Americans. Does not show that tailored assessment improves pain care. Does not measure pain or treatment use.

  Limits:

  Small, mostly female, older convenience sample from one metropolitan area with Korean-language resources; the authors say this may limit transferability and underrepresent more isolated immigrants. Focus groups may have suppressed some accounts. People with cancer-related pain were excluded. The passage is the authors' interpretation.

  Source: The Journal of Pain (Kim HJ, Kim S, Torres C, Sim W, Fillingim RB); abstract via PubMed; author manuscript via PubMed Central, Beliefs about pain and lived experience of chronic pain among Korean Americans in the community: A qualitative study (Abstract, Perspective statement (J Pain 2026;44:106306); Theme 5 (language barriers) and Theme 8 (pain self-management strategies) in the PMC author manuscript). Where: United States (Baltimore-Washington metropolitan area). Population: Foreign-born Korean American adults with chronic non-cancer pain (n=15; 73% female; mean age 65). Published 2026-05-03; retrieved 2026-10-11.

• Australia · Reported experience · 2022

  In a Queensland study with 21 Aboriginal and Torres Strait Islander patients and hospital liaison officers, participants identified differences in how pain is expressed and difficulty using standard pain measurement scales.

  What others could learn: A number on a one-to-ten scale may not carry what a person means by their pain. Some patients told a liaison officer about pain they did not tell clinicians, so a trusted third party may help if the person wants that. Patients said physical pain sometimes came second to family and community responsibilities.

  Conditions, limits and source

  Conditions that matter:

  Trust depended on acknowledging historical and cultural factors, more Indigenous staff, and respect for cultural protocols, including those about gender and age. Some patients feared different treatment if they disclosed their background.

  Cannot be inferred:

  Does not represent all Aboriginal and Torres Strait Islander people or communities. Does not test any alternative way of assessing pain. Does not measure pain outcomes or access.

  Limits:

  Purposive sample of 21 from three clinics and two hospitals in one state. Aboriginal and Torres Strait Islander patients were 4% to 8% of patients at the participating services. The abstract does not split participant numbers between patients and liaison officers.

  Source: Frontiers in Pain Research (Bernardes CM, Houkamau K, Lin I, et al.); full text via PubMed Central, Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia (Abstract, Results (Front Pain Res 2022;3:1041968); Results theme 'Scales do not measure patient pain' and liaison officer accounts in the PMC full text). Where: Australia (Queensland). Population: Aboriginal and Torres Strait Islander patients attending three persistent pain clinics, and Aboriginal and Torres Strait Islander Hospital Liaison Officers in two hospitals (n=21). Published 2022-12-06; retrieved 2026-10-11.

• The sourced examples include guidance, measured outcome, reported experience, policy, service in operation. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.