100 million Americans have chronic pain

More than 100 million Americans suffer from chronic pain at a cost of around $600 billion a year in medical treatments and lost productivity, according to a report from the Institute of Medicine (IOM).

An IOM committee commissioned by Congress concluded that pain is not optimally managed in the U.S. and that effective treatment of chronic pain will require a coordinated national effort to transform how the public, policy makers, and health care providers view the condition.

The report included recommendations for achieving what the committee referred to as a "cultural transformation" in how Americans understand and approach pain management and prevention.

"We see that for many patients chronic pain becomes a disease in its own right," committee chair Phillip Pizzo, MD, of Stanford University School of Medicine, said at a Wednesday news briefing. "We need to address this in a more comprehensive and interdisciplinary way and include prevention as a very important goal."

New pain medications needed

Pizzo said the IOM analysis probably underestimates the costs of chronic pain in the U.S. because the research did not include children and military personnel.

Committee member Sean Mackey, MD, PhD, noted that about a third of the population is affected by chronic pain -- more people than are affected by heart disease, diabetes, and cancer combined -- yet very little is spent on research to find better ways to manage pain.

Mackey is chief of the division of pain management at Stanford.

Opiods and nonsteroidal anti-inflammatory medications remain the main drug treatments for pain.

"We have been using the same agents in one form or another for hundreds of years," Mackey said, adding that new classes of drugs are desperately needed to prevent and manage chronic pain.

The shortage of pain specialists in the U.S. and a poor understanding of pain by general practitioners remains a major barrier to effective pain management, Pizzo said.

The committee members called on the Department of Health and Human Services (HHS) to develop a comprehensive population-based strategy for addressing pain prevention as well as pain management and research by the end of 2012.

Other recommendations included:

• Calling on the HHS and other government agencies to develop strategies for reducing barriers to pain care by 2012.
• Take steps to support more collaboration between pain specialists and primary care physicians.
• Called on federal officials to improve the collection and reporting of pain data and expand and redesign pain education programs by the end of 2015.
• Designate a lead institute at the National Institutes of Health responsible for overseeing pain research.

Taking pain seriously

The committee did not call for the creation of a government agency devoted solely to pain prevention and management, noting that the current economic downturn would make it unlikely that such an agency would be funded.

Committee vice chair Noreen M. Clark, PhD, noted that the federal government's efforts to combat drug abuse have lead to "extraordinarily burdensome" prescribing practices for patients with chronic pain.

Clark directs the Center for Managing Chronic Disease at the University of Michigan, Ann Arbor.

She noted that many of the more than 2,000 public comments on the committee's web site addressed this issue.

"It is extraordinary how many people described themselves as collateral damage in the war against drugs," she said at the Wednesday briefing. "Patients are paying the price for policies not designed for their benefit."

Chronic pain sufferer and journalist Melanie Thernstrom, who also served on the committee, noted that there is an overwhelming body of research to show that pain can be a disease and not just a symptom.

"I think if the public understood this and demanded that their pain be taken as seriously as diabetes, or asthma, or high blood pressure or any number of other health problems that damage the body are taken, you would see a change," she said.

By Salynn Boyles

Reviewed by Laura J. Martin, MD