The Charter of Rights against unnecessary pain was promoted by Cittadinanzattiva in 2005 with the aim to declare and protect a group of rights still too often violated.
It was drawn up soon after the information campaign "Let’s abolish unnecessary pain” and has benefited from the collaboration of a number of people active in the field:

• AIMEF, Associazione Italiana Medici di Famiglia
• AIOM, Associazione Italiana di Oncologia Medica
• ANMAR, Associazione Nazionale Malati Reumatici
• ANTEA onlus - Azienda Ospedaliera Le Molinette di Torino
• FIMMG, Federazione Italiana Medici di Medicina Generale
• SIAARTI, Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva
• SIFO, Società Italiana Farmacisti Ospedalieri
• SIMG, Società Italiana di Medicina Generale
• SIOT, Società Italiana Ortopedia e Traumatologia
• SIR, Società Italiana Reumatologia

The Following Charter intends to inform citizens about pain and promote its prevention, control and treatment; the subscription to the Charter is entrusted to citizens’ organisations involved in safeguarding health rights, as well as healthcare professionals and the institutional bodies exerting governing responsibilities at different levels. To download the Charter click here

1 Right not to suffer unnecessarily
Every individual has the right to have his/her pain alleviated as efficiently and rapidly as possible.
In the past, ignorance, prejudice and resignation have prevented to adequately address pain associated with disease. In fact, pain is a symptom that should be treated with the same care used in preventing the disease in order to avoid it becoming chronic and thus become a "disease" in itself.
It is therefore necessary to build a new cultural approach towards suffering and unnecessary pain and make pain therapy an integral part of the therapeutic process. Every individual has the right to know that pain must not be necessarily tolerated, but that much of the suffering can be relieved and cured by intervening with the right therapy. Pain must be eliminated, or at least mitigated where possible since it heavily affects the quality of life. It is a right which must be recognized and respected always and everywhere, from hospital wards to long term care facilities, from the emergency rooms to the patients’ homes.

2 Right to the acknowledgement of pain
Every individual has the right to be listened to and believed when reporting personal pain.
Pain has a strong subjective component, since the individual who is suffering from it is affected by many factors, as clearly shown by the literature on this issue. To intervene in a more appropriate manner, operators have a duty to listen, believe and consider the suffering. Citizens must be free to report the pain, with their own way of describing it and feeling it, without fear of the doctor’s judgment, which in turn has the duty to interpret in the best way what the patient is trying to communicate.

3 Right to access pain therapy
Every individual has the right to access the treatment needed to alleviate pain.
There are currently still many limitations regarding access to pain relief. The greatest obstacle is represented by a cultural bias, which persists in the medical profession, also due to the lack of specific training for both university students and professionals. In addition to these resistances there are also excessively rigid procedures, such as the failure to consider certain types of pain, concerns of an economic-financial nature and the widespread inadequacy of health facilities. To make the treatment of pain accessible what are essential are the recognition and the sharing of a series of key requirements:

• consideration and care for the pain experienced by the patient should be a quality standard in the professional and an ethical duty of the entire team of operators, regardless of ethical, religious or philosophical beliefs, in order to ensure the assisted the best possible quality of life;
• all types of pain deserve equal consideration, no matter what the pathology or event that may have caused it. Therefore, even people nearing the end of their life have the equal right to be cared for and also those who suffer from chronic non-cancer pain and acute pain (childbirth, trauma from surgery or those who needs to be treated at A&E) and, in particular, all women should be allowed to decide (according to their clinical situation) to give birth without pain;
• public health services must be able to provide adequate assistance to pain both inside and outside health facilities. The latter should provide a service in pain therapy (simple or complex, depending on the quality and quantity of services provided) qualitatively compliant with the latest international guidelines and able to ensure appropriate treatment to all those in need. Access to treatment on the territory must be guaranteed especially through home services referring to the WHO guidelines, ensuring an easier availability of prescription and administration of medication and avoiding the suspension of continuity of care;
• drugs and techniques for the treatment of pain, and all the technical stages for their correct administration, must be among the public health system services offered to all citizens. Every individual has a right to access innovative procedures according to international standards, without economic or financial impediments.

4 Right to qualified assistance
Every individual has the right to receive pain assistance in observance of the latest approved quality standards.
Everyone has the right to receive assistance to relieve pain by properly trained and updated professionals, so as to guarantee the respect of the international quality standards.
It is necessary that the knowledge of the issue of "pain" (now considered the fifth vital sign), its quantification (measurement of pain) and treatment options become professional skills among all health operators, in order to guarantee citizens alleviation of their suffering, even in the absence of specialists. It is important that the measurement of pain be carried out through validated methods at international level and that its registration be indicated in the medical record. It is unacceptable that, even when laws provide tools to facilitate the prescription of opiate drugs, patients are denied the preparation or that doctors and practitioners are unprepared or unavailable.

5 Right to continued assistance
Every person has the right to have his/her pain relieved continuously and assiduously throughout all phases of illness.
Pain should be regularly monitored in all phases of the disease; continuity of care could be hindered by inadequate attention to the development of the disease and the absence of the necessary therapy readjustment. Particular attention should be placed in the transition from hospital to the territory, avoiding situations of discontinuity or unavailability of operators or unavailability of drugs and hospitals.

6 Right to a free, informed choice
Every person has the right to actively participate in the decisions made regarding pain management.
All decisions involve correct, complete and clear information, taking into account the cultural level of the patient and his/her emotional state. Any therapeutic intervention aimed at relieving the suffering must be agreed upon and regulated according to both quality and intensity, in agreement with the full and informed will of the patient, according to the principles which underpin a good informed consent. Every person has the right to receive prompt and clear answers to questions and have all the time necessary to take the resulting decisions.

7 Rights of children, the elderly and those “without a voice”
Children, the elderly and “sensitive” subjects have the same right not to suffer unnecessary pain; special consideration should be given to their particular status.
The assessment and treatment of pain in children has been ignored for a long time. The medical establishment, in fact, is often happy to transfer to children the knowledge already developed by treating adults rather than undertake research and specific studies, which take into account childhood and its psychological implications.
Fear and anxiety present in all individuals dealing with the disease are different in ill children, in people with mental illnesses or severe mental disabilities and some elderly patients. These patients have difficulty in expressing their pain and therefore its reading is not recorded properly due to the lack of an integrated approach.

8 Right not to suffer pain during invasive and non-invasive diagnostic tests
Anyone having to undergo diagnostic tests, especially those which are invasive, must be treated in such a manner as to prevent episodes of pain.
Some invasive diagnostic exams are not calmly faced when there is fear for the pain they can cause.