Proceedings of a Workshop
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This activity was supported by contracts between the National Academy of Sciences and the U.S. Social Security Administration (Contract #28321323D00060012/Task Order #28321324FDS030149). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2025. Exploring the treatment and management of chronic pain and implications for disability determinations: Proceedings of a workshop. Washington, DC: National Academies Press. https://doi.org/10.17226/29181.
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PLANNING COMMITTEE ON EXPLORING THE TREATMENT AND MANAGEMENT OF CHRONIC PAIN AND IMPLICATIONS FOR DISABILITY DETERMINATION1
ALLEN HEINEMANN (Chair), Northwestern University
TAMARA BAKER, University of North Carolina at Chapel Hill
ANIRBAN BASU, University of Washington
REUBEN ESCORPIZO, University of Vermont
JUAN HINCAPIE-CASTILLO, University of North Carolina at Chapel Hill
KIM DUPREE JONES, Emory University
SEAN MACKEY, Stanford Medical School
CHRISTOPHER STANDAERT, University of Pittsburgh
ANNA WILLIAMS, Clusterbusters
HENRY XIANG, The Ohio State University and Nationwide Children’s Hospital
Project Staff
REBECCA A. ENGLISH, Senior Program Officer
AUSTEN APPLEGATE, Research Associate
ELIANA PIEROTTI, Senior Program Assistant
SHARYL NASS, Senior Director, Board on Health Care Services
National Academy of Medicine Fellow
SEBASTIAN TONG, University of Washington
Consultant
JOE ALPER, Science Writer
___________________
1 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop has been prepared by the workshop rapporteurs with assistance from the National Academies of Sciences, Engineering, and Medicine staff as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies, and they should not be construed as reflecting any group consensus.
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Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by CLARION JOHNSON, ExxonMobil (Ret.). He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. We also thank National Academies staff member Anthony Janifer for reading and providing helpful comments on this manuscript. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
The National Academies of Sciences, Engineering, and Medicine wish to thank all the members of the planning committee, who collaborated to ensure a workshop replete with informative presentations and moderated rich discussions, as well as the speakers, who generously shared their expertise and their time with workshop participants. Funding from the Social Security Administration made this workshop possible.
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Contents
2 OVERVIEW, CONCEPTS, AND FRAMING OF CHRONIC PAIN AND DISABILITY
Disability Adjudication Policy
The Social Evolution of Chronic Pain
3 FACTORS AFFECTING ACCESS TO EFFECTIVE CHRONIC PAIN CARE
Biological Mechanisms of Socially Determined Pain and the Implications for Pain Management
Chronic Pain, Disability, and Aging Across Identities
4 METHODS AND METRICS FOR CHRONIC PAIN ASSESSMENT IN ADULTS AND CHILDREN
Living with Rheumatoid Arthritis
Current Evidence to Support Best Practices in Measuring and Assessing Chronic Pain
Living with Multiple Serious Health Conditions, Including Complex Regional Pain Syndrome
Psychological Interventions for Youth with Chronic Pain
Prevalence of Chronic Pain in Children
Considering Innovative Approaches for the Treatment of Chronic Pain in Children
6 CONSIDERING BEST PRACTICES ON CHRONIC PAIN TREATMENT AND MANAGEMENT IN ADULTS
An Overview of Chronic Pain in Adults
Chronic Pain Management from a Psychologist’s Perspective
Clinician Perspectives on Chronic Pain Treatment and Management in Adults
7 PATIENT JOURNEYS AND CLINICIAN PERSPECTIVES IN TREATING AND MANAGING CHRONIC PAIN
The Lived Experience of Chronic Pain
Treating Chronic Pain in Uninsured Patients: A Pharmacist’s Perspective
Improving Access to Pain Care: A Public Health Opportunity
8 HEALTH CARE SYSTEM CHALLENGES IN COMPREHENSIVE CHRONIC PAIN MANAGEMENT
Patient Experiences with Social Security Disability
Accessible Behavioral Pain Care
Health Care System Challenges in Comprehensive Chronic Pain Management
9 COMPLEMENTARY AND ALTERNATIVE THERAPIES IN COMPREHENSIVE CHRONIC PAIN MANAGEMENT
The Complementary and Integrative Pain Management Toolbox
Mindful Movement for Chronic Pain
Acupuncture and Acupressure for Chronic Pain
Integrative Solutions for Pain and Disability in the Veterans Administration
10 EMERGING RESEARCH ON NEW OR IMPROVED METHODS FOR MEASURING AND MANAGING CHRONIC PAIN
The Future of Chronic Pain Assessment
Emerging Pharmacotherapies for Pain and Headache Disorders
Developments in Neuromodulation for Pain
Percutaneous Peripheral Nerve Stimulation
Emerging Digital Technologies for Measuring and Managing Chronic Pain
Co-creating Pain Therapeutics: Where Innovation Meets Lived Experience
11 KEY CHALLENGES AND OPPORTUNITIES IN CHRONIC PAIN AND DISABILITY
B Biographical Sketches of the Planning Committee and Workshop Speakers
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Boxes, Figures, and Table
BOXES
FIGURES
2-1 Overlap of many painful conditions
4-1 The multiple factors contributing to pain
4-2 Types of clinical outcome assessments
5-1 U.S. pediatric pain clinics, 2025
5-2 Applying an individual lens for patient-centered pain care
8-1 The benefits of brief treatment for chronic pain
8-2 Demographics of patients served at federally qualified health centers
9-1 The complementary and integrative pain management toolbox
9-2 Multiple components of a biopsychosocially informed intervention for chronic pain
10-1 Pain biomarker categories and examples of their use
10-2 Composite, multimodal biomarker signatures for chronic pain
10-3 Real-world decision dilemmas make risk–benefit decisions complex
TABLE
8-1 Lessons Learned Partnering with Federally Qualified Health Centers
Acronyms and Abbreviations
| ACT | acceptance and commitment therapy |
| CBT | cognitive behavioral therapy |
| CIPM | complementary and integrative pain management |
| EHR | electronic health record |
| FDA | Food and Drug Administration |
| FQHC | federally qualified health center |
| GET | graded exposure treatment |
| MBSR | mindfulness-based stress reduction |
| NLP | natural language processing |
| RA | rheumatoid arthritis |
| SGA | substantial gainful activity |
| SSA | Social Security Administration |
| TCQ | tai chi/qigong |
| VA | Veterans Administration |
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