Pain is a universal experience. Common chronic pain conditions affect approximately 100 million U.S. adults at a cost of $560-635 billion annually in direct medical treatment costs and lost productivity. Pain’s occurrence, severity, duration, response to treatment, and disabling consequences vary from person to person because pain, like other severe chronic conditions, is much more than a biological phenomenon and has profound emotional and cognitive effects. Pain can be mild and easily handled with over-the-counter medications; it can be acute and recede with treatment; it can be recurrent over months or years; or it can be chronic and debilitating, requiring almost constant attention and accommodation.

Many shortfalls in pain assessment and treatment persist despite humanity’s intimate familiarity with pain throughout history, modern appreciation for the complexity of its origins and the diversity of its effects, and the not insubstantial risk that any one person may have serious or chronic pain at some point. In general, these shortfalls arise through gaps in policy, treatment, attitudes, education, and research. Why and how these gaps might be remedied was the focus of the Institute of Medicine’s (IOM’s) Committee on Advancing Pain Research, Care, and Education.


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 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 (see Chapter 1 for the committee’s statement of task).

This report responds to the committee’s charge 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. The report does not provide an exhaustive review of the literature examining the science of pain and its diagnosis and treatment. Nor does the report present a clinical algorithm for the diagnosis and treatment of patients with pain. Rather, it describes the scope of the problem of pain and provides an overview of needs for care, education, and research. The committee’s recommendations are based on both scientific evidence and expert judgment.

Several important underlying principles informed the committee’s approach to its charge. These principles are presented in Box S-1.

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