Pain Should Be Getting Our Attention!

August 23, 2010

The Affordable Care Act was signed into law on March 23, 2010. As health care reform is implemented and the United States continues to devote extensive resources to health care; there are real opportunities to improve health care quality and equity by improving pain care. Specifically, pain research practice and policy can substantively inform the broader national health care policy debate (Green 2008). Pain has reached epidemic proportions with nearly 100 million Americans living with acute, chronic, cancer pain or pain due to a terminal illness. Yet pain is a silent epidemic, and pain care is plagued by problems with access, assessment, treatment, quality, and disparities (Green, Anderson et al. 2003). Aging baby boomers and increased survival from catastrophic injuries, cancer, and diabetes will yield dramatic increases in the prevalence of pain and has long term implications on the nation’s health and well-being. The epidemic coincides with problems in health care access, quality, and disparities. Thus, undiagnosed, untreated, and under-treated pain is a significant public health problem.

Overall, pain complaints are a leading cause for all physician visits, health care costs, and disability in the United States. A recent issue brief from the Center for Healthcare Research and Transformation highlights the cost of pain in Michigan and the nation, as well as gender differences. Several of the most frequent diagnoses and costliest procedures were due to pain, with Vicoden™ the most commonly prescribed medication. Clearly PAIN should be getting our attention! Pain is a thief in the night that steals America’s mental health, sleep, economic productivity, physical health, and family relationships. The physical, societal, and emotional cost of pain are particularly important as the U.S. ages and diversifies.

Currently, individuals greater than 65 years old use more medications to control pain than any other segment of the population. Racial, ethnic, gender, age, class, and community-related differences in the pain experience are well documented with the pain complaints of minorities, women, and the elderly receiving less attention and lesser quality care (Green, Ndao-Brumblay et al. 2005). Thus, a tsunami of pain is approaching. Altogether these findings illustrate considerable structural barriers to quality pain care and highlight the significant public health and health policy implications. However, a clear disconnect exists between the goals for pain relief and the funding. Without needed improvements in pain assessment and treatment as well as managing the co-morbidities accompanying pain such as sleep disturbance, depression, anxiety, and disability, the increasing prevalence of pain will have devastating socioeconomic implications for all Americans. Thus, pain care provides many opportunities to direct health and social policy but state and federal funding and attention is lacking.

It is imperative that pain is included in a substantive manner in ongoing discussions regarding health care reform, continuing education for health care professionals, and public discourse. Optimizing pain care is a neglected topic in medicine with most health professionals receiving minimal education. The Joint Commission on Accreditation of Hospitals and Healthcare Organizations and others (e.g., VA) elevated pain to a health system priority. However, there is a significant gap between the health care dollars spent on doctor’s visits, medications, lost work productivity, worker’s compensation, and long term disability due to pain complaints, when compared to dollars spent on primary prevention and research (Green 2008). There is considerable variability in clinician education and knowledge, attitudes, and decision-making; complicating efforts designed to improve the quality of health and pain care. These factors contribute to suboptimal pain assessment and treatment yielding several challenges for health care planning.

The good news is that policy makers were listening to the voices of millions of people living with pain when they included the National Pain Care Policy Act within the Affordable Care Act, thereby providing hope for an interdisciplinary agenda designed to improve the science and reduce the burden of pain for millions of Americans and their families. The bad news is that this portion of the law was authorized but not appropriated. Thus, Congress must appropriately fund and make a worthwhile investment in a comprehensive pain care and research agenda to improve the health and well-being of millions of Americans living with pain. Substantial improvements in health and reductions in disability are achievable by delivering high quality, high value, and equitable pain care. The failure to commit to a worthwhile investment in a comprehensive pain agenda will have long lasting socio-economic consequences for our nation.

Carmen Green is a Professor of Anesthesiology, Professor of Obstetrics and Gynecology, and Professor of Health Management and Policy at the U-M Medical School and a member of CHRT’s board of directors.

Other Resources


1. Green, C. R. (2008). “The Healthcare Bubble through the Lens of Pain Research, Practice, and Policy: Advice to the New President and Congress. Editorial.” The Journal of Pain 9(12): 1071-1073.

2. Green, C. R., K. O. Anderson, et al. (2003). “The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain.” Pain Medicine 4(3): 277-294.

3. Green, C. R., S. K. Ndao-Brumblay, et al. (2005). “Differences in Prescription Opioid Analgesic Availability: Comparing Minority and White Pharmacies across Michigan.” The Journal of Pain 6(10): 689-699.