About the Discussion

@NEJM Ask the Authors & Experts: Intensity of Chronic Pain — The Wrong Metric?

Perspective

Intensity of Chronic Pain — The Wrong Metric?

Pain causes widespread suffering, disability, social displacement, and expense. Whether the issue is viewed from a moral, political, or public health perspective, pain that can be relieved should be relieved. Yet the most rapidly effective drugs for relieving pain — opioids — are caught up in a morass of concerns about addiction. Achieving a balance between the benefits and potential harms of opioids has become a matter of national importance.

The United States recently established a national plan to address pain, as Canada, Australia, Portugal, and Malaysia have previously done. This National Pain Strategy grew out of recognition by the Institute of Medicine (now the National Academy of Medicine) of the enormous burden of chronic pain in the United States. For three decades, there has been hope that more liberal use of opioids would help reduce the number of Americans with unrelieved chronic pain. Instead, it produced what has been termed an epidemic of prescription-opioid abuse, overdoses, and deaths — and no demonstrable reduction in the burden of chronic pain.