The Cost and Management of Chronic Pain

Abstract

Chronic pain is a significant public health problem in the United States, affecting more than 50 million adults. It ranks among the costliest chronic health conditions due to high healthcare utilization, disability rates, and lost worker productivity. Most patients with chronic pain are managed in primary care. Yet, primary care clinicians face significant barriers when managing patients with chronic pain, as they navigate patients’ multifaceted pain histories under time constraints. Digital health technology, such as clinical decision support (CDS) systems can provide PCCs with relevant patient information through streamlined workflows to improve care, yet they are often underutilized. At the same time, there is a lack of evidence on the national incremental healthcare costs of chronic pain, making it challenging to allocate limited healthcare resources effectively. Thus, there is a significant need for evidence to guide both economic and digital health technology strategies to improve pain care for millions of adults with chronic pain. This dissertation addresses critical gaps in the cost and CDS system management of chronic pain by: 1) estimating the incremental annual healthcare costs associated with chronic pain using nationally representative data; 2) examining how primary care clinician characteristics moderate the relationship between patient encounter characteristics and CDS system use; and (3) evaluating the effect of CDS use at a patient encounter on guideline-recommended chronic pain management. Findings from the cost analysis can help policymakers and health systems more accurately target investments in chronic pain care and assess the value of intervention strategies. Findings from studies on CDS system use provide actionable insights to inform the design, targeting, and implementation of digital health technologies that enable more efficient, evidence-based care for patients with chronic pain.