2020 Blueprint for Relieving Pain in America

A blueprint for transforming prevention, care, education, research, and relieving pain in America.
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Chronic pain affects roughly 20 percent of US adults, which amounts to one in five people. It is one of the most common reasons people seek medical care and has been linked to a massive network of mental and physical conditions, presenting a huge drain on people’s lives and morale, as well as the economy. To name just a few issues that link back to chronic pain, chronic pain significantly correlates with anxiety, depression, opioid misuse, reduced quality of life, and disability.

More than just a single condition, chronic pain (and pain in general) represents a massive issue that affects Americans across all ages and demographics, but disproportionately affects women, the poor, and those living in rural conditions, and provides insight into the state and efficacy of the American healthcare system.

When a crisis affects one in five Americans, it should become a matter of highest priority. And while chronic pain affects an individual’s health, there are many reasons why relieving pain is a public health concern, rather than a simple healthcare issue.

Among many other things, chronic pain represents a massive money sink for the US, and given the nature of its indirect impact in many other crises (such as the rapidly growing opioid epidemic), public policy needs to play a larger role in the development of policies and supervision and funding of critical research to help stop this national hemorrhage, and reduce the number of adult, working-age Americans facing daily and unending pain.

Why Chronic Pain Is More Than a Feeling

The moment a problem begins to affect a significant portion of the nation’s people is the moment that problem begins to take on such a humongous shape that public policy changes become necessary to relieving pain.

More than just a feeling, chronic pain is a condition diagnosed by pain that lasts for more than three months, or about twelve weeks. While pain is typically an acute sense triggered by some sort of damage or emergency, chronic pain represents a persistent pain signal that the body and/or brain can’t or won’t shut off.

The most common kind of chronic pain, by far, is chronic back pain, typically triggered by an injury or a type of arthritis. Chronic back pain is common enough that it is estimated that more than 80 percent of Americans will experience chronic back pain at some point in their lives, and it is the leading cause of disability in the US.

All chronic pain is either nociceptive, neuropathic, or unidentified. Nociceptive pain is tissue pain – pain felt in the region from where it originated, typically due to an injury to the tissues in that area. Examples include a bee sting or a broken bone, but in cases of chronic pain, this includes most kinds of arthritis and most headaches.

Neuropathic pain describes pain triggered by nerve damage. Impingement, dead nerves, a central nervous system disease, or any other condition or injury that results in damage to the nervous system can lead to neuropathic pain. Chronic examples that hundreds of thousands of Americans suffer from include sciatica and multiple sclerosis.

Whether nociceptive, neuropathic or unknown, chronic pain is constant and disruptive. Different conditions lead to different deficits in a person’s quality of life, with an estimated 8 percent of adults struggling with what is defined as ‘high-impact chronic pain’, which is defined as chronic pain accompanied by one or more major ‘activity restrictions’, which include being unable to work, unable to study, unable to do chores, unable to leave the home, and so on. Due to the effect chronic pain has on productivity and the healthcare system, it is estimated that the annual cost of chronic pain lies at about $635 billion, eclipsing the annual cost of cancer, heart disease, and diabetes.

Treating and Relieving Pain on a National Level

In order to effectively address what relieving pain means and what it would take on a national level, the condition needs to be fought on multiple levels. It is the role of public policy in the healthcare system to identify effective strategies with which to:

• • Educate the public on the significance of a healthcare threat.
  • Educate the public on its causes and methods of prevention (lifestyle changes, etc).
  • Educate the public on the manner in which the condition is treated, and who to turn to next (primary care physicians, pain specialists, urgent care facilities).

Public institutions must band together to pool resources in an effort to better identify treatments for chronic pain, fund the research of alternative analgesics to opioids, and identify effective policies that can reduce the prevalence of chronic pain, and the incidence of chronic pain at the workplace and elsewhere.

Hospitals and healthcare facilities must do more to reduce conflicting medical advice, better screen for chronic pain or conditions that may link to chronic pain, avoid duplicative tests, more quickly refer people to pain specialists, and develop a larger network of pain specialists that primary care physicians can refer to. The Institute of Medicine’s Committee on Advancing Pain Research, Care, and Education also identified several other sectors that are needed to help address pain in the US:

• • Educational institutions for healthcare professionals.
  • Healthcare system and its delivery components (clinics, hospitals, and other practices).
  • Research sector (for establishing new ways of tackling, preventing, or intervening with chronic pain).
  • Businesses and employers (who affect health insurance coverage).
  • Policy makers (who must address and regulate matters such as drug marketing, dispensing of addictive pain medication, insurance coverage of pain services, etc).
  • Pharmaceutical companies and medtech industry (for producing better analgesics).
  • Health organizations (who help provide an interface between consumers and the healthcare industry).
  • The media (affecting public opinion and disseminating information on chronic pain).
  • Accrediting/licensing bodies (for setting the standards for practices and physicians in the treatment of chronic pain).

Relieving Pain Is a National Issue and Effort

Chronic pain as a national issue is a two-way street – just as chronic pain affects society on every level, only a multipronged approach from several sectors of society can properly address and help quell the damage caused by chronic pain.

The best way to address this problem is through a nationwide effort, in the form of epidemiologic studies, clinical studies, and the use of public monies to better equip individual professionals and larger practices with the means and information to treat their patients properly, and provide treatment to a wider range of Americans.

The US Institute of Medicine Committee published an excellent book on the need for a concrete and step-by-step plan towards tackling chronic pain on a national level in its 2011 book, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. An excellent read for anyone interested in how the nation’s leading healthcare organizations and regulatory bodies can continue to come together to find more effective solutions to chronic pain conditions and alleviate its immense cost on human lives and the economy.