Pain research accounts for only about 1 percent of research grants awarded by the National Institutes of Health (NIH), a massive, unjustifiable disparity given the imbalanced proportion of U.S. health care expenditures attributed to pain.
"The federal government's limited investment in pain research is terribly out of sync with the prevalence and impact of chronic pain in our society, which is estimated at 100 million, or one in three Americans, and accounts for more than 25 percent of all physician office visits," said Roger B. Fillingim, Ph.D., president of the American Pain Society and professor of psychology at the University of Florida. "This inadequate funding is not attributable to recent budget cuts at NIH, because pain research was woefully underfunded even when funding for NIH was at all time high levels."
Fillingim noted that health economists from Johns Hopkins University writing in The Journal of Pain (www.jpain.org) in 2012 reported that the annual cost of chronic pain is as high as $635 billion a year, which exceeds yearly costs for cancer, heart disease and diabetes. Mean health care expenditures for adults were $4,475. Persons with moderate pain had health care expenditures $4,516 higher than someone with no pain, and individuals with severe pain had costs $3,210 higher than those with moderate pain. Also, adults with pain reported missing more days from work than people without pain. Pain negatively impacts three components of productivity: work days missed, number of annual hours worked and hourly wages.
In 2011, the Institute of Medicine published "Relieving Pain in America: A Blueprint for Transforming Prevention, Treatment, and Research," which sounded a clarion call for the nation to take immediate and aggressive measures to reduce the enormous medical, social and economic toll of chronic pain.
"The IOM report was a wake-up call that we should not try to resolve Washington's budget crisis on the backs of those who suffer every day from persistent pain conditions," said Fillingim. "The best hope for achieving significant advances in pain prevention and treatment is through directing a more appropriate level of funding for pain research grants that will translate advances in pain science into relief for patients."
Fillingim added that the IOM report recommended that federal agencies and private funders of pain research should increase support for interdisciplinary research in pain, public and private funders should increase the conduct of longitudinal research in pain, and, with the support of NIH, academic institutions should increase the training of pain researchers.
"The nation's pain research agenda must confront the reality that current pain treatments only help a small percentage of chronic pain patients and, knowing that some medications have serious side effects and risks for misuse, we really don't have the ability to predict who will benefit and who will be harmed," said Fillingim. "A key task for pain researchers, therefore, is to learn much more about the pathophysiology of pain and be able to better match patients with effective treatments and harness the promise of personalized medicine to develop, new multimodal approaches to pain management based on the patient's entire biopsychosocial milieu."
According to Fillingim, research has shown there are distinct neurobiological foundations for chronic pain that are significantly different from acute pain mechanisms. As a result, future pain studies should explore the unique factors responsible for chronic pain and develop effective treatments. Meantime, many with chronic pain could get meaningful relief with better access to currently available interdisciplinary treatments that work.
"Treating the whole person, not just the pain, is what multidisciplinary pain management is all about. For more than three decades, the American Pain Society has promoted and advocated the multidisciplinary approach to treating chronic pain," said Fillingim. "Investments in pain research will further demonstrate the benefits of the multidisciplinary approach in treating pain, not as the consequence of a specific disease, but rather as a multi-faceted human condition characterized by suffering related to myriad sensations, thoughts, emotions and behaviors, all within a social context. Since pain has many facets, no single outcome captures all of the relevant issues, and that's where the research challenges lie."
About the American Pain Society
Based in Glenview, Ill., the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. APS was founded in 1978 with 510 charter members. From the outset, the group was conceived as a multidisciplinary organization. The Board of Directors includes physicians, nurses, psychologists, basic scientists, pharmacists, policy analysts and others. For more information on APS, visit americanpainsociety.org