More than 50 million U.S. adults experience chronic pain, defined as pain lasting three months or longer. Of these, 17 million experience high-impact chronic pain, which often limits daily activity. Chronic pain is more common among older adults, women, American Indian or Alaska Native people, those living in rural areas, and adults who are publicly insured, unemployed, or living in poverty.

A 2011 report from the National Academies of Sciences, Engineering, and Medicine estimated that chronic pain contributes to between $560 billion and $635 billion each year in direct medical costs, lost productivity, and disability programs. Chronic pain presents one of the most complex public health challenges—a condition that not only taxes the body but also strains a person’s overall sense of well-being. 

For decades, the National Institutes of Health (NIH) has invested in research to better understand and treat chronic pain. This work recognizes that pain is more than just a physical symptom and that effective prevention and treatment require more than medication alone. This multidisciplinary research has provided diagnostic and treatment advances that have helped millions of Americans. 

Understanding the behavioral and social factors that shape how people experience pain will further progress in this field. Factors like stress, social support, and health behaviors interact with biological and psychological processes. These interactions are central to the biopsychosocial model, which looks beyond physical causes to explore how mental and social conditions affect pain and response to treatment.

The NIH Office of Behavioral and Social Sciences Research (OBSSR) plays a coordinating role in this work, partnering with NIH institutes, other federal agencies, and the research community to support studies on chronic pain. Recent and ongoing NIH initiatives bring together experts across disciplines to explore integrated treatments—combining medication, cognitive behavioral therapy, mindfulness, and patient education—to improve pain management and quality of life.

A key focus for OBSSR has been applying behavioral and social science to help address the opioid crisis. In 2018, as part of the Helping to End Addiction Long-term^® Initiative, or NIH HEAL Initiative^®, OBSSR co-led a workshop with other NIH institutes to identify contributions of social and behavioral research in addressing the opioid crisis. As a follow-up, OBSSR commissioned a special issue of the American Journal of Public Health that highlights how behavioral and social sciences can incorporate diverse perspectives to improve outcomes related to pain and opioid use. OBSSR staff and NIH colleagues also authored a commentary outlining current activities in this area, aiming to inform researchers, practitioners, and policymakers about ongoing work and future opportunities. In addition, OBSSR supported an administrative supplement funding opportunity (NOT-OD-20-101) focused on strategies to reduce stigma around pain management and opioid use disorder.

Through the NIH Blueprint for Neuroscience, OBSSR also supports research (RFA-AT-21-003) on interoception—how the brain senses and interprets signals from the body—a promising area for understanding chronic pain.

Looking ahead, the continued integration of behavioral, social, and biomedical research will be critical to improving chronic pain care. NIH-supported studies are helping clarify how social context, mental health, and biological factors influence pain. This knowledge will facilitate the development of treatments that are more personalized, effective, and accessible. 

Several important questions remain:

• How can we better involve communities in pain management strategies?
• What role can new technologies play in enhancing behavioral interventions?
• How can we ensure that research findings lead to real improvements in care and policy?

Answering these questions will require continued collaboration across disciplines—and a commitment to addressing pain not just as a symptom, but as a complex condition that touches every part of a person’s life.