The healthcare bubble through the lens of pain research, practice, and policy: advice for the new President and Congress.

m r v ( l n a a o s the United States struggles with healthcare reform, an opportunity exists to consider how pain research and pracice can serve as a model to inform the roader national reform and policy deate. Ensuring healthcare quality (ie, efectiveness, efficacy, and access to healthare) requires sound research to benefit ndividuals and society. Pain has reached pidemic proportions. The epidemic coinides with problems in accessing quality ealthcare, medical errors, and healthcare isparities throughout the entire system. Similar to the general population, people iving with pain often face financial and ther structural barriers to quality healthare and pain care (including the absence of nsurance, underinsurance, and poverty). hus, undiagnosed, untreated, and underreated pain remains a significant public ealth problem. Overall, pain significantly iminishes health-related quality of life and nancial well-being, yielding increased disbility, functional limitations, and increased epression and anxiety (including post-trauatic stress disorder) among pain patients, ompared with the general population. ew knowledge is a critical tool. Thus, pain esearch provides many opportunities to diect practice and policy—including economic, ealth, and social policy—but federal funding or pain research is lacking. A unique database, the article by Bradshaw t al provides evidence that funding for pain esearch has continued to decline since 2005. he National Institutes of Health (NIH) is a maor funding source for biomedical research. hus, it is disturbing to see a continued downard trend in total NIH funding and for NIH rimary pain research funding in particular. verall, the NIH allocated minimal funding— ess than 1%—to primary pain research. A odest, initial 12% increase in funding ocf urred from 2003 to 2004 and was followed by 9.4% annual reduction from 2004 to 2007. ore specifically, when measured as the perentage of total NIH funding, primary pain reearch funding reached a high of 0.78% in 004 and fell steadily to a low of 0.6% in 2007. urprisingly, the reduction in primary pain reearch funding was greater than the overall IH funding reduction. Thus, there is a “recesion” in total funding with an accompanying depression” in primary pain research fundng. This is a critically important consideration s the prevalence of pain continues to inrease, with nearly 100 million people curently living with pain. When combined with increasing survival rom cancer and catastrophic injuries and ging baby boomers (ie, Americans born beween 1946 and 1960), pain will increase in revalence, interfere with successful aging, nd have immediate and long-lasting indiidual and socioeconomic consequences. Imortant considerations include (1) the elerly population ( 65 years old) use more edications to control pain than any other egment of the population, and (2) the baby oomers will become elderly in less than 3 ears. Without improving the ability to asess and treat chronic pain, the increasing revalence will have devastating socioecoomic and health consequences for all mericans. Diminished federal funding may comproise quality of treatment and threaten the esearch infrastructure necessary to (1) deelop hypotheses that extend pain research from bench, bedside, or the community evel) to understand the underlying mechaisms and expression for both pain and anlgesia; (2) encourage and support trainees nd scholars who are focusing their careers n pain research (jeopardizing an already ragile academic pipeline); (3) design inno-