As discussed in Chapter 2, pain is experienced by virtually everyone yet is unique in its perception and experience for each person. Accordingly, broad recommendations such as those offered by the committee can yield general change, but not improvement that will be palpable to every affected individual. A standard clinical algorithm for diagnosing and treating every patient lies well beyond the scope of this report (and may not be achievable in any event). The committee did not analyze the complexities of individual pain conditions and diseases associated with pain. Nor did it analyze in depth the controversies surrounding opioid abuse and diversion. However, the committee hopes that its findings and recommendations will be transformative for the lives of many of the approximately 100 million American adults experiencing chronic pain and those with acute pain as well.

The committee determined that transforming pain prevention, care, education, and research will require carefully planned and coordinated actions by numerous leaders and organizations. Many actors should contribute to the formation of a new national pain strategy. For example, the NIH Pain Consortium should be strengthened and its activities expanded. A comprehensive strategy will ensure that actions to address the problem of pain will be both efficient and effective.

The recommendations in this report are designed to assist policy makers; federal agencies within and outside the Department of Health and Human Services; state and local health departments; primary care practitioners; pain specialists; other health professionals; health care provider organizations; health professions associations; private insurers; researchers; funders; educators; pain advocacy and awareness organizations; the public; and, most important, people living with pain and their families, friends, and colleagues. The ultimate goal is to improve outcomes of care and return people to their maximum level of functioning. The basis for the committee’s recommendations consists of scientific evidence, direct testimony, and the expert judgment of the committee’s diverse membership. Principles underlying the recommendations were presented in Chapter 1 (Box 1-2). They include

  • pain management as a moral imperative,
  • chronic pain as sometimes a disease in itself,
  • the value of comprehensive treatment,
  • the need for interdisciplinary approaches,
  • the importance of prevention,
  • wider use of existing knowledge,
  • recognition of the conundrum of opioid use,
  • collaborative roles for patients and clinicians, and
  • the value of a public health- and community-based approach.

This chapter organizes the recommendations presented in Chapters 2 through 5 into a blueprint for action by identifying them as either immediate or near-term



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