When U.S. medicine declared pain “the fifth vital sign” in the 1990s, it was a call to take patients seriously. At its core was the belief that tracking pain as carefully as the other four vital signs—heart rate, blood pressure, temperature, and breathing rate—would improve care. But when opioid promoters co-opted this new standard with unethical marketing campaigns, prescriptions for opioid painkillers surged throughout the 2000s. Even after peaking in 2012, opioid-involved deaths continued to rise sharply through 2020.
The national reckoning forced by the epidemic came far too late for the families of more than half a million Americans lost to opioid-involved overdoses since 2000. In the overdue backlash that followed, pharmaceutical executives were called to account. Providers corrected course on their opioid protocols. And in a healthier America, doctors would have filled the void with safe, effective non-opioid medications for patients in pain—especially chronic pain.
Instead, the pendulum had swung too far. Our healthcare system pushed patients with pain to the margins.
In sober reflection, it became increasingly clear that opioids don’t even work for most people with non-cancer pain. In addition to being dangerously addictive, there is no credible evidence that opioids are effective for treating chronic pain. At the same time, safe and nonaddictive pain relief options remain under-prescribed, in part because of reimbursement barriers and inequities in care for vulnerable patients.
To make matters worse for patients with legitimate pain, heightened scrutiny of opioids spilled over to all pain medications, leaving pain care inconsistent and underfunded. Millions of people in real pain have been left adrift to battle doctors’ distrust and fragmented care. And in the rush to distance medicine from the ravages of lethal opioid misuse, an important truth was lost: Chronic pain is a credible condition that demands treatment.
Now it’s more prevalent than ever. Approximately one in four U.S. adults lives with chronic pain—the nation’s leading cause of long-term disability and a driver of billions in medical costs and lost productivity each year. It’s also a marker of illnesses from diabetes and cancer to fibromyalgia and osteoarthritis—and is linked with anxiety, depression, and other mental health needs. So when providers view pain through a lens of suspicion, they overlook its purpose as a biological messenger.
Chronic pain is a never-ending alarm that compounds fatigue and brain fog as it steadily erodes well-being. This suffering is one of the top reasons people see a doctor, and deserves to be a national health priority. In the shadow of a shameful opioid crisis, there are effective non-opioid analgesics that can improve people’s lives—if prescribed and if patients have the coverage to afford them.
By coordinating policy, education, and clinical practice, we can deliver proven nonaddictive pain treatment as a measure of health and dignity. The FDA and drug developers should work together to advance the agency’s blueprint for modernizing non-opioid analgesic development. Clinicians should be trained to recognize pain early and respond with evidence-based empathy, making better use of non-opioid therapies. Reimbursement and clinical guidelines must support responsible treatment. Proposed legislation ensuring Medicare coverage of non-opioid treatments for chronic pain could be life-changing for millions.
Predatory opioid marketers turned an idea that was right into something wrong. Pain is still a vital sign—a marker of distress. It’s time to confront the opioid epidemic’s collateral damage. Our healthcare policies and practices should move beyond the past to amplify both science and compassion. For conditions signaled by pain, we can intervene early to meaningfully improve patient outcomes. It’s a critical warning we ignore at our peril. How we respond now will shape the next era of health in America.