By R Carter
NIH funding In 2014 was 30 billion in taxpayer funds to improve the health of the nation. Chronic pain is as prevalent as cancer, heart disease and diabetes combined, yet in 2014, the NIH spent 95% more on these than it did on chronic pain. Why is this? We have no declared crisis for diseases of the heart, cancer or for diabetes, yet the funding for these massively outweighs a problem which has all but been declared a national emergency.
Despite out cries that the dollar cost burden to our society for chronic pain is as high as $635 billion annually, the NIH’s research funding for chronic pain is dismal in comparison to other diseases.
|NIH Goals for Chronic Pain|
NIH publications on goals for chronic pain treatment are to restore functionality and return individuals to productive members of society. Despite these high ideals, actual actions taken by the NIH tell a different story. Without funding for research into better treatments or long term effects of exiting treatments, such as opiates, chronic pain patients continue to languish in a sea of contradictions put forth by our government. On one hand they site the lack of research as justification for not using opiates and on another they hamstring efforts to collect such data by failing to fund research in amounts commensurate with other diseases.
In 2010, the National Institutes of Health (NIH) contracted with the Institute of Medicine (IOM) to undertake a study and make recommendations “to increase the recognition of pain as a significant public health problem in the United States”. The resulting 2011 IOM report called for a cultural transformation in pain prevention, care, education, and research and recommended development of “a comprehensive population health-level strategy” to address these issues.
|NIH Total Budget for Pain Research|
Four years after declaring a health crisis or epidemic, NIH data 2014 – 2017 shows how much, in millions, is spent from the 30 billion allocated. Research to improve the use of opiates has remained about the same, while funding for non-opiate, non-opiate chronic pain and either cannabis or cannabis opiate combinations has increased. Also important to note is how research in prescription opiates has increased, with a primary focus not on their medicinal use but on abuse or abuse prevention and detection. This is consistent with the notion that prescription opiates are major contributor of addiction, a view which remains inconclusive based on the data. Therefore it is an assumption without facts, but remains a corner stone of government policy.
Totals funding for all types of pain research for each year were as follows:
- 2014 = $498,635,086
- 2015 = $463,090,712
- 2016 = $482,907,817
- 2017 = $515,503,600
A lion share of the totals continues to be for identifying and treating opiate abuse, addiction identification and some treatment. And while strictly speaking these are not pain issues, a large portion of the budget goes for funding them.
While abuse occurs in less than 5% of chronic pain patients, conventional thinking remains that exposure to opiates under any condition is a major contributor to abuse and addiction. After this length of time and with the lack of data for connecting the dots between chronic pain treatment with opiate addiction, one has to ask why government policy continues to pursue the idea. The conclusion which comes to mind is that such a pursuit is not rational, but instead the agenda of an anti-opiate minority.
|Policy Follows Research Funding|
From the NIH’s data it’s clear that where research goes, policy will follow. And while it’s positive to see more research done for chronic pain, the emphasis remains on non-opiate treatment options for chronic pain. It’s true that despite research to date, there have been no treatments found which have the benefits of opiates without the down side of opiates. What I take from reviewing dozens of papers is this, is that opiates are and will continue to play a major role in chronic pain management. That said the emphasis in research remains on the draw back to opiates, their abuse, physical dependence, identification of addiction and treatment for it.
Research into the long term benefits of opiates gets less than $500,000 in funding each year.
While not included in this graph, data from 2016- 2017 shows increased funding for research into opiate minimums in elective surgery procedures. This is in line with recent announcements in 2019 of some hospitals adopting goals of reducing the use of opiate in elective surgery and trauma, by 80%. With a greater emphasis on regional blocks using long acting local anesthetics for managing pain while in the hospital. But, these goals also impact the use of opiates at discharge following a hospital stay. The same hospitals advocating large reductions in opiates also support sending patients home without opiates after a minimal hospital stay. Whether or not this will be widely received and accepted remains to be seen. There is little funding for this perspective, so I tend to believe such ideas are more in line with anti-opiate zealots acting on their own as opposed to a major push from all researchers to minimize opiate exposure to opiate naïve patients.
The anti-opiate mentality pervades every aspect of government policy with the most often sited reason as, the risk for addiction. Yet research shows inconclusive detrimental effects, with the exception of addiction. Most long term chronic pain patients, those with more than 6 months of treatment with opiates, have less than a 5% failure rate into addiction. While often not sited in research, one of the reasons for such a minimal failure rate is because early detection and identification has improved significantly yielding the highest success rates at combating opiate addiction ever.