A Review of Chronic Noncancer Pain: Epidemiology, Assessment, Treatment, and Future Needs

Abstract

The 2011 Institute of Medicine report Relieving Pain in America estimates that 100 million adult Americans are affected by chronic pain, costing a staggering $560 billion to $635 billion annually. In the context of this immense personal and socioeconomic burden, it is essential that all stakeholders, including providers, patients, third-party payers, and policy makers, understand the necessities of appropriate, accurate assessment and treatment of patients with chronic pain. This review examines the psychosocial consequences of pain and existing disparities in treatment. Particular emphasis is given to the challenge of using prescription opioids in the treatment of chronic noncancer pain, given the ongoing epidemic of deaths from prescription opioid overdose. Strategies for initial risk assessment and ongoing monitoring are discussed for detecting opioid misuse, abuse, and addiction. In addition, the challenges of treating patients with comorbid pain and substance use disorder are reviewed, and the role of the addiction specialist is highlighted. The biopsychosocial model of pain is reviewed as a framework for the interdisciplinary, multimodal approach to pain management, which is often necessary to treat patients with complex chronic pain conditions and comorbid psychiatric diagnoses. An interdisciplinary team consisting of pain specialists, mental health providers, physical/occupational therapists, nurses, and primary care providers is necessary not only for ongoing assessment of multiple relevant outcomes but also for overseeing the delivery of multimodal treatments (e.g., medications, interventions, physical/occupational therapy, and psychosocial education). To move toward personalized treatment of patients with pain, future needs in research, clinical care, and education are discussed.