Every year, at least 116 adult Americans experience chronic pain, a condition which costs the nation more than $635 billon annually, but much of this pain is preventable or could be better managed, says a new report.
The US needs coordinated, national efforts by public and private organisations to create a "cultural transformation" in how the nation understands and approaches pain management and prevention, according to the report, which is produced by a committee of the Institute of Medicine (IoM).
Moreover, the National Institutes of Health (NIH), academic researchers and other public organisations need to collaborate with private firms to advance R&D into new and improved therapies, the authors recommend.
"All too often, prevention and treatment of pain are delayed, inaccessible or inadequate," said committee chair Philip Pizzo, a professor of paediatrics and of microbiology and immunology at Stanford University School of Medicine in California.
"Patients, health care providers and our society need to overcome misperceptions and biases about pain. We have effective tools and services to tackle the many factors that influence pain and we need to apply them expeditiously through an integrated approach tailored to each patient," he added.
A new analysis undertaken as part of the study finds that the medical costs of pain care and the economic costs related to disability days and lost wages and productivity amount to at least $560-$635 billion a year, but this is a conservative estimate because the range does not include costs associated with pain in children or military personnel, the authors note.
Health care providers, insurers and the public need to understand that, although pain is universal, it is experienced uniquely by each person and that care - which often requires a combination of therapies and coping techniques - must be tailored, they add.
Moreover, pain is more than a physical symptom and is not always resolved by curing the underlying condition; persistent pain can cause changes in the nervous system and become a distinct chronic disease, the report notes. It also emphasises that individuals' experience of pain can be influenced by genes, cultural attitudes towards hardships, stress, depression, ability to understand health information and other factors - behavioural, cultural and emotional.
Successful treatment, management and prevention of pain requires an integrated approach, and for the most part, care and management should take place through primary care providers and patient self-management, with specialty care services reserved for more complex cases, the report recommends. Health care organisations need to take the lead in developing innovative approaches to coach and empower patients in self-management, while health care professionals' training programmes should include pain education; at present, only five of the 133 medical schools in the US have required courses on pain, and just 17 offer elective courses, it notes.