As a pain physician with over 20 years of experience treating patients with chronic pain, I hear the same plea almost every day: “Doctor, it hurts, please help.”

As an author and patient advocate, I wanted to verbalize the daily reality of chronic pain.

Chronic pain affects an estimated 24.3 percent of U.S. adults (approximately 60 million people) as of 2023, with 8.5 percent (about 21 million) experiencing high-impact chronic pain that limits life or work activities. These numbers have risen significantly since the pre-pandemic era, underscoring a growing public health crisis.

Pain is inherently subjective. While the underlying tissue damage or nerve dysfunction may be measurable, the lived experience of pain varies widely from person to person. A foundational concept in modern pain management captures this truth: Pain is inevitable, but suffering is optional. This idea, drawn from mindfulness practices and cognitive-behavioral approaches, emphasizes that while the sensation of pain may persist, the emotional and mental anguish surrounding it can often be mitigated through targeted interventions.

A comprehensive toolbox for pain relief

Effective pain management extends far beyond medication. The standard of care today is a multimodal, multidisciplinary approach that addresses the physical, psychological, and functional dimensions of pain. Core tools include:

• Targeted exercise and physical therapy to strengthen supporting structures, improve mobility, and reduce mechanical stress on painful areas.
• Psychological strategies such as cognitive-behavioral therapy (CBT), mindfulness, and “mind-over-matter” techniques that help patients reframe their relationship with pain and reduce suffering.
• Medication management used judiciously, including nonopioid options when appropriate.
• Interventional procedures such as nerve blocks, injections, or neuromodulation, tailored to the specific pain generator.

Guidelines from the CDC and professional societies strongly endorse this combined approach for subacute and chronic pain, prioritizing nonpharmacologic and nonopioid therapies while reserving opioids for cases where benefits clearly outweigh risks. The true art of pain medicine lies in skillfully orchestrating this “cocktail” of interventions to match each patient’s unique needs, goals, and circumstances.

When successful, this strategy restores function, reduces reliance on emergency departments, enhances quality of life, and enables patients to remain productive members of society. It transforms chronic pain from a disabling condition into a manageable one.

The growing burden of regulation

Despite these clinical advances, practicing pain medicine has become increasingly challenging. Regulatory oversight from the DEA, FDA, state medical boards, and other authorities, while well-intentioned in addressing the opioid crisis, has created an environment of defensive medicine. Physicians now practice with constant vigilance, documenting every decision meticulously to avoid scrutiny that could jeopardize their license or practice.

The 2016 CDC opioid prescribing guideline, in particular, led to widespread unintended consequences, including abrupt tapers, patient dismissals, reduced access to care, and in some cases, worsened patient outcomes such as increased illicit drug use or mental health crises. Even the more flexible 2022 update has not fully reversed the culture of fear. Many clinicians report hesitating to accept new chronic pain patients or prescribe necessary therapies due to concerns over audits, investigations, or legal action.

This overzealous application of rules, which sometimes get twisted by prosecutors or boards without sufficient regard for clinical nuance or the human element and sometimes weaponized against doctors, has strained the physician-patient relationship. Policies that limit physician autonomy indirectly restrict patients’ access to timely, personalized care. Good-faith physicians who balance evidence-based treatment with risk mitigation now face daily anxiety that a well-intentioned decision could later be second-guessed.

Advocating for patients and physicians

I have long sought to amplify the voices of both patients and the physicians who serve them through published articles and advocacy. At the heart of health care must remain the patient as the individual in pain seeking relief and dignity. Yet regulatory frameworks increasingly seem to overlook this core truth, layering on restrictions that make it harder for dedicated clinicians to provide comprehensive care.

I consider myself a patient advocate first. I also advocate strongly for the many ethical physicians who navigate these complexities daily in good faith. They balance complex treatment decisions against evolving rules, all while fearing that any misstep, whether real or perceived, could lead to professional ruin.

Toward a more balanced future

Chronic pain management requires nuance, expertise, and compassion. Regulations should support safe, effective care without creating insurmountable barriers or punishing clinicians for practicing evidence-based medicine. We need policies that incorporate the human factor: the reality of individual patient variation, the value of clinical judgment, and the profound impact of untreated pain on lives and communities.

Patients deserve access to skilled physicians who can offer the full spectrum of tools without undue fear. Physicians deserve a regulatory environment that distinguishes between reckless prescribing and thoughtful, patient-centered care.

By restoring balance and prioritizing both safety and access, we can better serve the millions living with chronic pain and fulfill medicine’s fundamental promise: to heal and to help.

Kayvan Haddadan is a physiatrist and pain management physician.