By Prof Felicia Marie Knaul, PhD Prof Felicia Marie Knaul, Prof Felicia Marie Knaul, Prof Paul E Farmer, MD*, Eric L Krakauer, MD*, Liliana De Lima, MHA, Afsan Bhadelia, PhD, Xiaoxiao Jiang Kwete, MD, Héctor Arreola-Ornelas, MSc, Prof Octavio Gómez-Dantés, MD, Natalia M Rodriguez, PhD, Prof George A O Alleyne, MD, Stephen R Connor, PhD, Prof David J Hunter, MBBS, Diederik Lohman, MA, Prof Lukas Radbruch, MD, María del Rocío Sáenz Madrigal, MD, Prof Rifat Atun, FRCP†, Prof Kathleen M Foley, MD†, Prof Julio Frenk, MD†, Prof Dean T Jamison, PhD†, M R Rajagopal, MD† on behalf of the Lancet Commission on Palliative Care and Pain Relief Study Group‡

In agonising, crippling pain from lung cancer, Mr S came to the palliative care service in Calicut, Kerala, from an adjoining district a couple of hours away by bus. His body language revealed the depth of the suffering.

We put Mr S on morphine, among other things. A couple of hours later, he surveyed himself with disbelief. He had neither hoped nor conceived of the possibility that this kind of relief was possible.

Mr S returned the next month. Yet, common tragedy befell patient and caregivers in the form of a stock-out of morphine.

The lack of global access to pain relief and palliative care throughout the life cycle constitutes a global crisis, and action to close this divide between rich and poor is a moral, health, and ethical imperative. The need for palliative care and pain relief has been largely ignored. Yet, palliative care and pain relief are essential elements of universal health coverage (UHC).

This Lancet Commission aims to (1) quantify the heavy burden of serious health-related suffering associated with a need for palliative care and pain relief; (2) identify and cost an essential package of palliative care and pain relief health services that would alleviate this burden; (3) measure the unmet need of an indispensable component of the package—off patent, oral, and injectable morphine; and (4) outline national and global health-systems strategies to expand access to palliative care and pain relief as an integral component of UHC while minimising the risk of diversion and non-medical use.

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