Pain Mgmt and Public Health: Special Series

Pain Management and Public Health: Introduction to the Special Section – free full-text /PMC6301426/ – Jan 2019

Three critical issues surround contemporary pain management and public health.

  • First is the assessment of pain management needs and evidence-based interventions on an individual and population basis.
  • Second is the tragic crisis of opioid use disorder in the United States and other developed countries.
  • Third is the fragmented response to the opioid crisis, which has resulted in some undertreatment of severe pain and essential pain medications becoming unavailable, even as overdose deaths involving opioids continue to increase.

This special section of AJPH on pain management focuses primarily on the first issue, pain management assessment and intervention, but it does so in light of the other two crucial and related issues.

The primary purpose of the special section is to document why pain, especially managing it, should be a high priority for public health policy, research, and practice.

The authors of the articles, commentaries, and editorials in the special section describe how pain, its treatment with opioids, and the consequences, both intended and unintended, of policies addressing it have evolved in the past 30 years.

They document the evidence, and gaps in evidence, showing that pain may be effectively treated.

They also identify challenges in creating policies that respond to the suffering and burden that pain imposes on patients and their loved ones, clinicians and caregivers, regulators, and society.

Some articles provide an international perspective, including the argument that preventing pain and increasing access to pain care provided by qualified personnel is a human right.

Overall, the articles support the view that a public health approach to pain management is essential to ensure that pain management receives appropriate attention and population-wide adoption.


Although the opioid crisis in North America and elsewhere is dominating current pain management policy, pain has been and will certainly continue to be a widespread and often unavoidable aspect of the human experience.

Efforts to enhance access to opioids, particularly for cancer-related pain and end of life care, are urgently needed in low-resource countries.

Most importantly, the dogmatism and politicization that has characterized many decisions in the recent history of pain control and opioid analgesia must be replaced by humility, compassion, and willingness to align the needs of multiple stakeholders in the interest of public health.

Here are the articles in this series, all free full-text PMC:

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