OR: Pain, Healthcare's Persistent Challenge, 6 unitsPage 4 of 22

2. The Experience of Pain

The Institute of Medicine (IOM) estimates that treatment and management of pain costs about $635 billion annually in the United States in direct medical costs and lost productivity (IOM, 2011). Despite these costs—approaching two-thirds of a trillion dollars a year—our failure to enact policies on pain treatment, education, management, and palliative care, along with the failure to put in place functioning drug supply systems, has hampered the development of consistent pain policies throughout the United States.

Although vast amounts of money are spent each year on the treatment and management of pain, it is inadequately treated in vulnerable populations. This includes women, children, older adults, ethnic minorities, patients with cognitive impairment, cancer patients, nursing home residents, and those with active addiction or a history of substance abuse. Untreated pain has a profound impact on quality of life and can have physical, psychological, social, and economic consequences (King & Fraser, 2013).

Among African Americans, lower rates of clinician assessment and higher rates of undertreatment have been found in all settings and across all types of pain (IOM, 2011). Similar results have been found among Hispanics, Asian Americans, and Native Americans. These disparities among racial and ethnic minorities are related to lack of provider education, system-level lack of access to pain medications, and cultural beliefs about pain (Makris et al., 2015).

Surprisingly, undertreatment of pain can be an issue even for those with diseases and conditions known to cause pain, such as cancer, HIV, and trauma. Conservative estimates by the World Health Organization (WHO) suggest that 1 million terminal HIV/AIDS patients, 5.5 million cancer patients, and 800,000 trauma patients have little or no access to treatment for moderate to severe pain (King & Fraser, 2013).

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