The Pain Drain: The Fiscal and Societal Burden of Chronic Pain

by Ben Borrow, M.D.

We find ourselves in the midst of an epidemic of persistent pain, with 100 million Americans affected by regular headaches, back, neck, abdominal and joint pain. Chronic pain is now the most common form of enduring illness for those under the age of 60, and it is breaking the proverbial bank for individuals and employers.

Pain has an enormous ripple effect on individuals, marriages, families, communities, businesses — our entire country. It adversely impacts quality of life and, from an economic viewpoint, it massively limits people’s functional status and ability to work. Pain affect our bodies, minds, spirits and financial health, which, in turn, contributes to how well we are able to cope with the many burdens and limitations associated with pain.

The economic costs of pain can be separated into two parts: the expense of medical treatment (e.g., doctors, hospitals, surgeries and medications) and the indirect costs due to reduced employee productivity (lost time of work and disability). Low back pain and osteoarthritis are among the top reasons for disability. In 2010, they represented more than 100 million years of productive life lost due to disability, according to the Institute of Medicine (U.S.) Committee on Advancing Pain Research, Care, and Education (

The same source estimates the sum annual cost of pain (in 2010 dollars) to be $635 billion, which dwarfs that of other major health problems such as heart disease ($309 billion), cancer ($243 billion) and diabetes ($188 billion). Furthermore, in these other major public health conditions, we are making steady forward progress, while the chronic pain and disability trends continue to increase.

In response to this problem, in 2013, we filled 207 million opioid prescriptions, and 2.1 million Americans are addicted to these pills, according to the National Institute on Drug Abuse ( How could we ever expect to be competitive with other countries when taking this much medication?

Why Chronic Pain Can Be So Hard to Treat

While there is still a lot that needs to be learned about how to optimally treat chronic pain, we do know that chronic pain signals can remain active in the nervous system for years after an injury, and sometimes pain even arises in the absence of any injury. Numerous studies confirm that our mindsets toward pain (and mindsets related to work) — particularly frustration, stress, timeline pressure, anger and excessive worrying — produce a cycle of pain, inactivity, deconditioning and low self-esteem. All this can prevent a return to productive work and life in general.

This does not mean that chronic pain is less real than acute pain. Rather, this underscores that there is much more to chronic pain than the physical (biological) aspect alone and that we need to view chronic pain from a broader perspective.

There are attainable workplace solutions that are also multifaceted, but all revolve around active employee engagement. One safe and effective approach to reducing chronic pain and returning to full work productivity is cognitive behavioral therapy (CBT). This is a form of talk therapy that helps people identify and develop skills to adjust negative thoughts and behaviors. Multiple studies have shown its efficacy. “Tele-therapy,” a budding form of delivering this, offers enormous potential to widely disseminate CBT to people so they can return to active life and work.

We are past due on the need to systematically address these issues and return our wellness and productivity balance sheets to the black.

Ben Borrow, M.D., is chief medical officer for The Pain Project, a new tele-therapy program and online resource that focuses on helping people understand and utilize their innate potential to “heal from within” using effective non-pharmaceutical approaches to chronic pain.

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