New Orleans—Pain research in the United States is severely underfunded, despite the fact that chronic pain costs the economy more than $600 billion annually in medical expenses and lost productivity. Although the 5% cut to the National Institutes of Health (NIH) budget across the board is partly to blame, it is not the only contributing factor, according to Roger B. Fillingim, PhD, professor, College of Dentistry, University of Florida, Gainesville, and director of the university's Pain Research and Intervention Center of Excellence. Dr. Fillingim, who also is president of the American Pain Society (APS), spoke with Pain Medicine News at the annual scientific meeting of the APS, and provided insight and recommendations on how to address this health issue that affects an estimated one in three Americans. Here is an abridged version of the discussion.
PMN: Apart from the cut in federal funding, what are other reasons for the lack of financial support for pain research?
Roger B. Fillingim, PhD
Professor, College of Dentistry
University of Florida
Dr. Fillingim: Part of it is, I think, a historical view that pain is simply a symptom of another thing; fix that other thing and the pain will go away. So [the view is] we don't have to fund pain research; [instead] we can fund cancer research and if we cure the cancer, any pain that may have been associated with it will be taken care of. Or the same thing for arthritis or whatever other condition pain may be associated with. It's relatively new that we more clearly view pain as a result of a pathophysiologic process of its own. For example, some of the recent studies in humans showing certain areas of the brain shrink as a consequence of chronic pain bring pain into the realm of a neurologic disease all its own. And there are many examples of pain conditions—even disease-associated pain conditions—that show that when you manage the disease process, the pain still persists. So pain can become a somewhat independent phenomenon, especially when it has persisted for a long period of time, and that's a relatively new appreciation. It's also relatively new that we fully understand how big a problem pain is: It has become a more substantial problem because we're aging, and a lot of conditions associated with aging are associated with pain. It's also because of the increasingly sedentary nature of society. But the economic analysis that identified that pain costs $635 billion a year was only published last year in the Journal of Pain.1 That fed into the Institute of Medicine's report that came out about a year earlier, which put a spotlight on the magnitude of pain many of us in the pain field had recognized before, but outside the pain field had been under-recognized.
PMN: How big an issue is pain?
Dr. Fillingim: Pain is responsible for roughly 10% of health care costs, and it is the No. 1 reason people seek health care. So we think, even with funding of 1% or 1.3% of the NIH budget, pain is woefully underfunded. Pain is an incredibly complex health problem because it has many shapes and forms, so to understand pain is going to take a lot of effort. Some decades ago, the government declared a "War on Cancer" and I think—although cancer hasn't been cured—there have been substantial advances in cancer survivorship. It would be wonderful if we declared a "War on Pain" and decided we're going to devote appropriate resources to understanding its pathophysiology; to developing new treatments; to making sure currently available treatments are disseminated to the patients who need them; and to better match patients to treatments—the whole personalized medicine approach. And I think, as a field, we are at a very exciting crossroads: We benefit from discoveries from other fields like the Human Genome Project. Our basic science community has made tremendous advances in understanding the neurobiology of pain mechanisms, and I think we're in a great position now to take all of those foundational areas of knowledge and those methodologies and translate them into reducing human pain-related suffering. But that takes people, that takes resources and that takes technology, and we're going to have to be adequately resourced to do that.
PMN: In an ideal world, if appropriate funding were available for pain research, how much money would suffice?
Dr. Fillingim: Maybe an ideal to strive for is a level of funding that's proportionate to the magnitude of the health condition. So how about 10% of the NIH budget? I just can't imagine that ever happening, but what I'd like to see is for our government to acknowledge pain as the major public health problem it is, and to make a clear commitment with resources behind it. I really don't want to take money from other health conditions. We want a bigger piece of the pie, but we need to grow the whole pie, and so we definitely need more funding across the board for biomedical research. I'd rather have new money infused into the pain research enterprise in order to make some of these targeted advances that I think we're poised to make. We're in a situation where we can't rely exclusively on the federal government to help us solve all our problems. We need to identify other sources of funding, like public–private partnerships. One concern is that industry is leaving the pain space. They find it challenging to develop pain drugs that ultimately make it to market or make business sense for them.
PMN: What, in your experience, is the general public's perception of the issue of pain?
Dr. Fillingim: A recent survey by Research America clearly reveals to us that the public doesn't acknowledge chronic pain as the major health problem it is.2 In the survey, more people thought the misuse of prescription drugs was a bigger issue than actually treating chronic pain: They were looking at it from a standpoint of "well, let's do something about these pain drugs and the abuse of them" as opposed to thinking about pain as a problem. That was a wake-up call for us when we saw that. But if we had better pain management, if more interdisciplinary pain management was available to patients who were suffering, I'm confident we would greatly reduce the need for prescription opioids and the frequency of prescription opioid adverse outcomes, whether that is abuse or other medical adverse effects. If we could do a much better job of managing pain with a multidisciplinary approach, which has been shown time and again to be the most effective, then we could take care of some of these unintended consequences as well.
- Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain.2012;13:715-724.
- Relieving Pain in America: A blueprint for transforming prevention, care, education, and research. Institute of Medicine; June 29, 2011. http://www.iom.edu/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research.aspx