September is Pain Awareness Month

September is Pain Awareness Month! It is a special month for us at the Institute for Chronic Pain (ICP). The theme of the month is one of the central goals of our mission. Specifically, our mission is to change the culture of how chronic pain is treated by promoting the theory and practice of chronic pain rehabilitation.

We raise awareness of the numerous personal, systemic, and societal issues related to chronic pain with the long-term goal of making the management of chronic pain more effective and cost-effective.

It’s no small task. Indeed, a critic might charge that we are pie-in-the-sky dreamers. However, the status quo is not acceptable.

And what is the status quo when it comes to chronic pain management? Consider these facts about the current state of affairs in the U.S.

  • The U. S. consumes 80% of all opioid medications prescribed in the world (Manchikanti & Singh, 2008).
  • The rate of spine surgery has been steadily and significantly increasing  over the last thirty years (Nilasena, Vaughn, Mori, & Lyon, 1995; Rajaee, Bae, Kanim, & Delamarter, 2012; Weinstein, et al., 2006).
  • The increase in the rate of interventional pain procedures has been described as “explosive” over the first decade of this century (Manchikanti, Pampati, Falco, & Hirsch, 2008).
  • Pain-related conditions remain the most common reason for disability and the rate of disability continues to increase (CDC, 2011).

Obviously, all this pharmacological, surgical, and interventional care is not helping.

Maybe, it is because as a society we are treating chronic pain in the wrong way. What if even the ways we think about the nature of chronic pain are wrong?

The ICP was founded and developed to resolve these issues. We attempt to foster consensus among the patients, providers, third-party payers, and public policy makers as to how to most accurately conceptualize chronic pain and how to most effectively treat it. We aim for everyone to more accurately understand that the nature of chronic pain is a biopsychosocial condition.

The leading scientific research clearly shows us that chronic pain is a nervous system condition that is biopsychosocial in nature, not an orthopedic condition (see, for examples, Apkarian, Baliki, & Geha, 2009; Baliki, et al., 2006; Chapman, Tuckett, & Song, 2008; Curatolo, Arendt-Nielsen, & Petersen-Felix, 2006; Meeus & Nijs, 2007; Woolf, 2011; Wieseler-Frank, Maier, & Watkins, 2005; Yunus, 2007).

Moreover, a large number of studies over multiple decades show consistent findings that chronic pain rehabilitation, an interdisciplinary therapy that focuses on down-regulating the nervous system, is the most effective form of chronic pain management (see, for examples, Flor, Frydrich, & Turk, 1992; Gatchel & Okifuji, 2006; Guzman, et al., 2001; Hoffman, Papas, Chatkoff, & Kerns, 2007; Turk, 2002).

At the ICP, we aim to tell the story of both these facts and do so in a way that’s credible and understandable to everyone. Thanks for supporting us!


Apkarian, A. V., Baliki, M. N., & Geha, P. Y. (2009). Towards a theory of chronic pain. Progress in Neurobiology, 87, (2), 81-97.

Baliki, M. N., Chialvo, D. R., Geha, P. Y., Levy, R. M., Harden, R. N., Parrish, T. B., & Apkarian, A. V. (2006). Chronic pain and the emotional brain: Specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain. Journal of Neuroscience, 26, 12165-12173.

Center for Disease Control. (June 21, 2011). 47.5 million U. S. adults report a disability; arthritis remains most common cause. Retrieved September 22, 2013, from

Chapman, C. R., Tuckett, R. P., & Song, C. W. (2008). Pain and stress in a systems perspective: Reciprocal neural, endocrine and immune interactions. Journal of Pain, 9, 122-145.

Curatolo, M., Arendt-Nielsen, L., & Petersen-Felix, S. (2006). Central hypersensitivity in chronic pain: Mechanisms and clinical implications. Physical Medicine and Rehabilitation Clinics of North America, 17, 287-302.

Flor, H., Frydrich, T., & Turk, D. C. (1992). Efficacy of multidisciplinary pain treatment centers: A meta-analytic review. Pain, 49(2), 221-230.

Gatchel, R., J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793.

Guzman, J., Esmail, R., Karjalainen, K., Malmivaara, A., Irvin, E., & Bombardier, C. (2001). Multidisciplinary rehabilitation for chronic low back pain: Systematic review. BMJ, 322(7301), 1511-1516.

Hoffman, B. M., Papas, R. K., Chatkoff, D. K., & Kerns, R. D. (2007). Meta-analysis of psychological interventions for chronic low back pain. Health Psychology, 26(1), 1-9. doi: 10.1037/0278-6133.26.1.1.

Meeus M., & Nijs, J. (2007). Central sensitization: A biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clinical Journal of Rheumatology, 26, 465-473.

Manchikanti, L., Pampati, V., Falco, F. J., & Hirsch, J. A. (2013). Growth of spinal interventional pain management techniques: Analysis of utilization trends and Medicare expenditures 2000 to 2008. Spine, 38(2), 157-168.

Manchikanti, L., & Singh, A. (2008). Therapeutic opioids: A ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician, 11(2suppl), S63-S88.

Nilasena, D. S., Vaughn, R. J., Mori, M. & Lyon, J. L. (1995). Surgical trends in the treatment of diseases of the lumbar spine in Utah’s Medicare population, 1984-1990. Medical Care, 33(6), 585-597.

Rajaee, S. S., Bae, H. W., Kanim, L. E., & Delamarter, R. B. (2012). Spinal fusion in the United States: Analysis of trends from 1998 to 2008. Spine, 37(1), 67-76. doi: 10.1097/BRS.0b013e31820cccfb.

Turk, D. C. (2002). Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. The Clinical Journal of Pain, 18, 355-365.

Weinstein, J. N., Lurie, J. D., Olson, P., Bronner, K. K., Fisher, E. S., & Morgan, T. S. (2006). United States trends and regional variations in lumbar spine surgery: 1992-2003. Spine, 31(23), 2707-2714. doi: 10:1097/01.brs.0000246132.15231.fe.

Wieseler-Frank, J., Maier, S. F., & Watkins, L. R. (2005). Immune-to-brain communication dynamically modulates pain: Physiological and pathological consequences. Brain, Behavior, & Immunity, 19, 104-111.

Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152 (3 Suppl), S2-15.

Yunus, M. B. (2007). The role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Practice Research in Clinical Rheumatology, 21, 481-497.

Date of last update: September 23, 2013

Author: Murray J. McAllister, PsyD