Like other developed nations, the United States has a major problem with chronic pain. Despite major advances at the scientific level in defining the nature and mechanisms of pain and the development of interventions for relieving pain, the chronic pain problem continues to grow [1
]. Several contributing factors exist. In developed nations, older populations increase because more people live longer. Longer lifespans mean that more people will develop diseases associated with chronic pain. In addition, more people survive catastrophic traumatic injuries that are likely to leave them with chronic pain. As the risk for chronic pain increases, the prevalence of chronic pain conditions continues to grow. Moreover, obesity is becoming a problem in developed countries and particularly in the United States. Obesity is a pro-inflammatory condition that increases the risk of chronic pain [4
]. The estimated prevalence of obesity in Americans aged 60 years and older was 37% for 2010 [6
]. Related to this is the lack of exercise and generally poor level of physical fitness in the United States, which are also associated with chronic pain.
The population of the United States is currently 313 million people. Of these, over 100 million suffer some form of chronic pain [1
]. Examination of the nation's priority health conditions reveals that 25.8 million Americans have diabetes, 16.3 million have coronary heart disease and 11.9 million have cancer. Clearly, chronic pain represents an enormous problem that is more prevalent than diabetes, heart disease and cancer combined. Physicians in most specialties regularly encounter chronic pain problems.
The cost of chronic noncancer pain to American society is at least $560-$635 billion annually, and this includes the loss of work productivity [7
]. This means that society loses about $2,000 per American citizen per year. In 2008 federal and state governments pain about $99 billion for pain related medical expenditures. The costs of chronic pain exceed those of diabetes, heart disease and cancer combined. Clearly, chronic pain is a major burden to American society.
The impact of undermanaged chronic noncancer pain on the patient is complex and serious [1
]. It compromises the individual's normal activities of daily living, interferes with sleep, reduces the productivity of the patient in the workplace, and degrades quality of life. Studies show that the risk of suicide among patients with chronic pain is approximately twice that for control groups. Moreover, chronic pain affects the families, friends and coworkers of individual patients. Family roles changes when pain disables one of the family members, and loss of productivity can impose a financial burden on the family.
The growing epidemic of chronic pain in America has set the stage for the opioid pharmacotherapy dilemma. Chronic pain, by definition, is neither self-limiting nor curable, and patients require skilled, effective pain management. By and large, chronic noncancer pain patients in the United States and elsewhere are under managed. The literature suggests that psychological interventions and physical therapies are effective, and interdisciplinary approaches appear to be the most cost-effective and definitive solutions to disabling chronic pain [8
]. Nonetheless, in the United States providers and payers resist these approaches, forcing patients to undergo mono-disciplinary medical treatment in most cases. Apart from certified pain specialists, most American physicians are poorly prepared to diagnose, monitor and manage chronic pain conditions. Simple, straightforward, monotherapeutic pharmacological interventions, such as opioid pharmacotherapy, appeal in many settings.