Advancing a National Agenda to Eliminate Disparities in Pain Care

In 2000, Congress passed the Minority Health and Health Disparities Research and Education Act (P.L. 106–525) establishing National Institutes of Health’s (NIH) National Center on Minority Health and Health Disparities (NCMHD; recently renamed as National Institute on Minority Health and Health Disparities, NIMHD) and charged the center with administering special grant programs focusing on disparities, coordinating minority health disparities research across NIH Institutes, and spearheading the development of an NIH-wide Strategic Plan on health disparities. This effort resulted in unprecedented developments, including 27 NIH Institutes and Centers developing individual strategic agendas to eliminate health disparities. Some of these agendas recognized the importance of disparities in pain care.

At about the same time, the 106th United States Congress passed Title VI, Section 1603, of H.R. 3244 declaring the era starting 2000 as the “Decade of Pain Control and Research”[1,2]. Subsequent high-profile pain initiatives included the Veterans Pain Care Act of 2008 (H.R. 6122), Military Pain Care Act of 2008 (H.R. 5465), and the National Pain Care Policy Act of 2009 (H.R. 756/S.660), provisions from which were included in the Affordable Care Act (ACA) signed in to law by President Obama in March 2010 [3]. These high-profile initiatives placed pain on the national agenda as a major public health problem—one with real social and fiscal consequences. The problem of pain cuts across disease entities and treatment settings. According to recent estimates, 116 million American adults suffer from chronic pain; pain remains the principal reason for which people seek medical care [4,5]. Chronic pain is strongly associated with societal costs measured in terms of disability, poor quality of life, relational problems, lost income and productivity, and higher health care utilization including longer hospital stay, emergency room visits, and unplanned clinic visits. The burden to Americans are reflected in an enormous annual expenditure that ranges $560–$635 billion in direct and indirect costs [5]—a marked increase from the previously estimated cost of $100 billion [6] and an estimated cost of employees’ chronic pain to businesses of $61 billion [7]. Despite chronic pain’s concerning socioeconomic impact, many aspects of pain care, training, and research remain grossly under-resourced [8,9]. Only less than 1% of the NIH research budget is invested in pain and symptom management research [10] (Box 1).

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