physician visits, among the most common reasons for taking medications, and a major cause of work disability. Severe chronic pain affects physical and mental functioning, quality of life, and productivity. It imposes a significant financial burden on affected individuals, as well as their families, their employers, their friends, their communities, and the nation as a whole. The annual economic cost of chronic pain in adults, including health care expenses and lost productivity, is $560-630 billion annually according to a new estimate developed for this study (see Appendix C).


Section 4305 of the 2010 Patient Protection and Affordable Care Act required the Secretary, Department of Health and Human Services (HHS), to enter into an agreement with the Institute of Medicine (IOM) for activities “to increase the recognition of pain as a significant public health problem in the United States.” Accordingly, HHS, through the National Institutes of Health (NIH), requested that the IOM conduct a study to assess the state of the science regarding pain research, care, and education and to make recommendations to advance the field. The charge to the committee is presented in Box 1-1.

To conduct this study, the IOM assembled a 19-member committee, which began meeting in November 2010. Reflecting the complexity of the problem at hand, the committee included experts in pain research, pain management, pharmacology, clinical specialties (pediatrics, oncology, infectious disease, neurology, neurosurgery, anesthesiology, pain medicine, dentistry, psychology, and complementary medicine), chronic disease, clinical teaching, epidemiology, ethics, and consumer education, as well as individuals who have suffered personally from chronic pain and could reflect on the perspectives of the many people it affects.


The challenges to better pain management in the United States are diverse. Some result from inadequate scientific knowledge about diagnosis and treatment and may be resolved by new research. Many of the challenges, however—those related to inadequate training and lack of understanding of the need to address the multiple physical, mental, emotional, and social dimensions of pain; to disparities in care among population groups; and to payment and policy barriers—reflect a failure to apply what is already known.

This report makes an important contribution to the field by providing a blueprint for transforming the way pain is understood, assessed, treated, and prevented. It provides recommendations for improving the care of people who experience pain, the training of clinicians who treat them, and the collection of data on pain in the United States, as well as a timetable for implementing measures to better relieve pain in America. The committee also recommends ways

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