Pain is the most common reason for seeking medical care. Although pain is experienced only by individuals, under federal policy, pain is a public health challenge, even a global health priority. In a way, this isn’t surprising, as modern definitions of health and public health are expansive, even including transitory mental and emotional states.
Public health as a concept arose along with eugenics during the Progressive Era. Although the two concepts weren’t completely congruent, both were compatible with government assuming authority to act on behalf of the health of the population.
Logically, a healthy community isn’t a thing. All populations include some individuals with disease or infirmity. But the concept of public health offers an opportunity for authoritarian control. Health-linked government actions extend beyond reasonable efforts like sanitation, clean water, and emergency stockpiles for disasters or epidemics.
Since 2010, the National Pain Strategy, created by the NIH and Institute of Medicine (IOM) has been our government’s “comprehensive population health-level strategy for pain.” The Federal Pain Research Strategy (FPRS) was added later. Congress has a Best Practices Inter-Agency Task Force to align with the NPS. The NIH has an Office of Pain Policy. The National Institute of Neurological Disorders and Stroke has an Office of Pain Policy and Planning.
The Executive Summary of the FPRS lists these priorities: “dissemination and implementation of research to support the translation of scientific discoveries into clinical practice and improve the lives of people in pain.” The IOM anticipates “cultural transformation in pain prevention, care, education and research” via population-level strategy.
The fact that millions of law-abiding Americans suffer chronic and severe pain is clearly not news to our government. Massive federal funds are earmarked for research seeking alternative pain treatments and shoring up unfounded links between prescribed opioids and opioid use disorder, overdoses, and deaths.
Since 2005, the Blueprint for Neuroscience Research has funded research initiatives, training opportunities, tools, and neuroscience resources focused on pain. Participating federal agencies include the National Center for Complementary and Integrative Health, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, and Office of Behavioral and Social Sciences Research. The Blueprint’s 2025 budget is $2.8 billion.
Helping End Addiction Longterm (HEAL) dominates internet searches related to pain care. Another collaboration of multiple federal agencies, HEAL funds 1,800 projects in 50 states and spent over $3 billion between 2019 and 2023. Research funded by HEAL includes opioid use disorder and addiction, managing pain while reducing opioid use disorder, preventing opioid use disorder and addiction, new and non-addictive analgesics, new pain targets and mechanisms, and finding links between pain and substance abuse.
“Opioid use disorder” — distinct from substance abuse disorder — was first incorporated in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) in 2013. NIMH refused to support DSM-5 because of inclusion of diagnoses not supported by laboratory measurements. NIMH shifted funding away from research based on DSM-5. Clearly, things have changed since then.
Drill into every federal funding opportunity involving pain, and the priorities are clear. Connect prescribed opioids with opioid use disorder, substance abuse, or addiction. Develop and promote non-opioid treatments. Promote non-opioid treatments whether they work or not (they don’t). Minimize prescribing and maximize demonization, as if prescribed opioids were a global threat to carbon-based life forms.
Problematic opioid use following a prescription is extremely rare. JAMA data published in 2016 on over half a million surgery patients not prescribed opioids for at least a year. A reference sample of 18 million subjects received no surgery or prescriptions. Subsequent opioid misuse ranged from 0.119–1.14% for the surgery patients and 0.136% for reference subjects. In 2018, the BMJ published data following over 2 million patients prescribed opioids for the first time after surgery. The post-surgery misuse rate was 0.6%. But federal budgets continue to support research seeking a link that years of data already disproved.
The Federal Pain Research Strategy Summary includes one key admission: “Novel pharmacologic treatments for pain have not emerged for some time.” Not for lack of spending.
Often treatments prescribed for pain are not opioids, despite lack of evidence that alternative treatments have any significant benefit. Psychiatric medications such as gabapentin, amitriptyline, and duloxetine have been prescribed off-label for decades, with scant evidence of efficacy. Gabapentin withdrawal symptoms are remarkably similar to opioid withdrawal. Spinal stimulation implants aren’t guaranteed to relieve pain, while patients have reported negative side-effects for years. No alternative has yet shown effectiveness for pain that comes close to opioids. All that can be inferred from existing evidence is that some physical treatments, like chiropractic, may help reduce pain in conjunction with an analgesic.
It’s almost refreshing to see an NIH publication admit that research focuses on “opioid use, misuse and addiction” with a “dearth of federal funding for studying interventional pain management.” Interventional pain management means invasive procedures, including spinal stimulation, nerve blocks, and surgery. Our modern medical establishment calls this a holistic approach. Existing opioids have no place in this vision of pain care.
In 2017, half of Americans had tried alternative treatments, but only 20% used them instead of conventional care. As of 2021, only 2% of Americans had tried acupuncture.
Among pain patients surveyed in 2024, 77% were willing to consider alternative treatments, and 65% were willing to try acupuncture. Pain makes people desperate. Desperation makes people vulnerable to unfounded ideas.
Untreated pain affects endocrine, cardiovascular, immune, neurological, muscle, and skeletal function. Pain patients suffer exhaustion, memory deficit, attention deficit, and cognitive decline. Decreasing activity, declining fitness, and increasing obesity are followed by joint weakness, neuropathies, muscle contractions, hypertension, and tachycardia. “Cardiovascular death is a common occurrence among persistent pain patients, likely due to a multitude of factors.”
Government funding for anything-but-opioids continues. Taxes pay for researching and promoting mindfulness (teaching pain patients what to think), swearing (when patients tire of being told what to think), placebos (faking re-classified as legitimate treatment), yoga (a religious practice), and deep brain stimulation. So much more than merely wires inside your skull, deep brain stimulation is wires inside your skull plus bilateral upper chest implants. When there’s effective oral medication (opioids), who would choose enough implants to qualify as a Borg?
The only transformation of pain care that should occur in the U.S. is to return prescribing decisions to doctors and stop government bureaucrats practicing medicine without a license.
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