management strategy at the population health level is needed. It is not sufficient to treat pain merely on a case-by-case basis in physicians’ offices and other health care settings.

Fourth, pain is costly to the nation—not just in terms of health care expenditures and disability compensation but also in terms of lost school days, lost productivity and employment, reduced incomes, and, indeed, lost potential and quality of life.

Fifth, pain raises societal issues that extend beyond individuals and their suffering. Specifically, the opioid medications that are effective for many people with pain also are subject to misuse and abuse, and ensuring that they are available for those who need them and not available to abusers necessitates cross-governmental efforts at all levels.

Sixth, the public’s health is greatly influenced by the graduates of the nation’s health professions training programs, many of which are heavily supported with public monies. From initial education through continuing education programs, health professionals need to learn more about the importance of pain prevention, ways to prevent the transition from acute to chronic pain, how to treat pain more effectively and cost-effectively, and how to prevent other physical and psychological conditions associated with pain.

Seventh, the ability to reduce pain’s impact on the public’s health can be strengthened as a result of new knowledge generated by the nation’s vital research establishment through basic, clinical, and translational research; epidemiologic studies; and analysis of care patterns and costs.

Finally, public health offers an infrastructure and a forum for developing strategies for preventing and addressing pain. Multiple federal agencies—such as the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), National Institutes of Health, Agency for Healthcare Research and Quality (AHRQ), Surgeon General, and Departments of Veterans Affairs and Defense—can interact with state and local public health agencies and private-sector partners to develop and implement public education efforts and other population-based interventions.

The Department of Health and Human Services’ (HHS) vision and strategic framework on multiple chronic conditions is an example of a multipronged effort to accomplish much of what a coordinated national initiative on pain might do (HHS, 2010b). The starting point for the HHS initiative was recognition of the high human and economic costs of multiple chronic diseases, many of which include a substantial pain component. Problems that result from having several chronic diseases mirror in many ways the challenges experienced by people with severe chronic pain: “poor functional status, unnecessary hospitalizations, adverse drug events, duplicative tests, and conflicting medical advice” (HHS, 2010b, p. 2). The kind of systems thinking and stakeholder involvement that went into the HHS strategic framework parallels what the public health community could accomplish in pain care.



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