Comprehensive Pain Care Overview

Pain is the most common and compelling reason for seeking medical attention.^1,2 The prevalence of chronic pain problems in the general adult U.S. population is high; estimates have ranged from 11% to 47% in recent large surveys depending on the specific sample, with a documented association between pain and impairment in physical and psychological functioning and lost work productivity.³ Recent estimates for the US cost of pain care range from US$560 to US$635 billion annually.⁴ This exceeds the annual expenditures for the nation’s priority health conditions (heart disease, cancer and diabetes) combined.⁵ Low back and neck pain, osteoarthritis (OA) and headache are the most common pain conditions in the United States and are leading global causes of disability in 2015 in most countries.⁶

This prevalence of pain is set in the context of the ongoing prescription opioid epidemic that continues to claim 130 lives a day in the U.S, where nearly 80% of heroin users reported misusing prescription opioids prior to heroin.⁷ The probability of long-term opioid use increases after as little as five days of prescribed opioids as the initial treatment of pain.⁸ While not addictive, nonsteroidal anti-inflammatory medications (NSAIDs) commonly used for pain carry risks of adverse events including gastrointestinal (GI) symptoms like nausea, abdominal pain, stroke, heart attack, renal failure and GI complications including acute and chronic bleeding as well as delaying healing of injury.^9,10 There are 16,500 deaths annually from NSAID-associated GI complications among rheumatoid arthritis (RA) and OA patients alone;^11,12 and as of the year 2000, 25% of all reported adverse drug reactions were attributed to prescription NSAID use.¹³

In response to the risks of pharmacological treatments for both acute and chronic pain, and more specifically to the ongoing opioid crisis, nonpharmacologic pain approaches are recommended as a first line of care by the Centers for Disease Control and Prevention (CDC)¹⁴ and the U.S. Food and Drug Administration (FDA),¹⁵ the Army Surgeon General Pain Task Force,¹⁶ the American College of Physicians (ACP),¹⁷ and as part of comprehensive pain care³ by the U.S Agency for Health Care Research and Quality (AHRQ),¹⁸ National Institutes of Health (NIH),¹⁹  the National Academy of  Medicine (NAM, formerly the Institute of Medicine IOM)¹⁰ and the Joint Commission (TJC).^20,21