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By Alexis Kayser
Healthcare Editor
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Dr. Adriaan Louw has heard the term "pain revolution" before. The physical therapist and scientist has been researching chronic pain for more than 30 years. Over the decades, he has witnessed the rise of opioid prescriptions—and seen them replaced by other prescription medications and invasive medical procedures. He has watched patients be dismissed as malingerers as doctors struggle to ease their debilitating symptoms.
For a while, it seemed to Louw and his small group of colleagues that no one really understood chronic pain. Patients were still hurting. The treatments they fought hard for didn't always work. "When I came into the profession, people told me, 'Oh, there's a pain revolution, there's a pain revolution!'" Louw told Newsweek. "I kept looking around, like, 'Where is it?'"
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But now, in 2025, Louw agrees with the diagnosis. There has indeed been a pain revolution, he said: a "huge" one. The science is advancing, and the mechanisms behind chronic pain are no longer a mystery.
So why is the problem getting worse? Newsweek interviewed more than a dozen of the nation's leading chronic pain specialists and researchers, asking why the number of chronic pain patients is rising if the science is truly accelerating.
Their consensus: We have the knowledge to treat chronic pain and even, in some cases, to cure it. But the U.S. health care system is not set up for the sort of treatments that patients need and our fee-for-service payment structure does not incentivize change.
As Louw put it, "We still have a lot of yuckiness in the medical world."
In 2023, nearly one in four adults struggled with chronic pain, or pain that persists for more than three months. That's a 4 percent increase from 2019, according to the most recent data from the Centers for Disease Control and Prevention.
Dr. Eellan Sivanesan is an anesthesiologist specializing in chronic pain at Johns Hopkins University's Blaustein Pain Treatment Center, and is its director of neuromodulation, a novel therapy for pain patients. Demand for his services has steadily increased over time, he told Newsweek.
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Sivanesan sees the rise of chronic pain as twofold. First, people are living longer due to medical advancements across specialties. As humans age, their bodies are susceptible to more wear and tear, like arthritis, degenerative spine diseases and post-surgical complications.
After the United States declared an opioid epidemic in 2011, the medical community began allocating more research dollars to chronic pain, and the stigma around these conditions waned. More people are seeking help for their pain as the topic becomes normalized, according to Sivanesan. "Chronic pain is increasingly recognized not as a personal weakness, but as a legitimate medical condition—one that deserves careful evaluation to identify its underlying cause and guide effective treatment," he said.
Chronic Pain Is a Silent Epidemic
This wasn't always the case for chronic pain patients. Dr. Allen Burton spent 20 years as an anesthesiology chronic pain specialist and saw lots of patients with debilitating symptoms and "unmet needs," he told Newsweek. For a long time, chronic pain was a silent epidemic.
"Often, those [patients] stay silent because there's a stigma associated often with chronic pain that the patients aren't tough enough or don't have enough moral fiber to just cope with the pain," he said.
Now, Burton is the medical director of Abbott's neuromodulation business, on the frontlines of treatment advancements for chronic pain patients. There have been more neuroscience advancements in the past decade than in all of history, he said. That research has led to a deeper understanding of chronic pain mechanisms.
Historically, pain signals have been viewed as cause and effect. When the body is injured, it pings the brain to rest, seek help or prevent further harm.
Medical schools train physicians to identify the underlying disease, according to Dr. Olufunke Pickering, senior medical director of Inovalon, a health care data and technology company that has conducted research on chronic pain and disease. Doctors tend to believe that pain should get better once that disease is treated. Ongoing pain is frequently perceived as a sign that something was missed: a tumor, inflammation markers in the blood, a bone that didn't heal properly. Except, that isn't always the case with chronic pain patients.
Recent research has demonstrated a strong link between chronic pain and the central nervous system, which consists of the brain and spinal cord. After an injury, illness or period of prolonged stress, a person's nervous system can change to become more sensitive to pain and other sensations. The brain can continue to send pain signals, even when the original threat is gone.
This phenomenon is known as central sensitization. Even in patients whose pain can be traced to a distinct diagnosis—like rheumatoid arthritis or lupus—up to 2 in 5 have a "prominent" central nervous system that is contributing to their pain, according to Dr. Daniel Clauw, director of the Chronic Pain & Fatigue Research Center at Michigan Medicine. "The studies now suggest 40 percent of the pain in osteoarthritis is coming more from the central nervous system, and the rest is coming from the knee or the hip or wherever you have the osteoarthritis," Clauw told Newsweek.
That understanding begs a multifaceted treatment approach, one that calms the overactive central nervous system rather than targeting a single achy joint.
Treatment Can Be a Painful Pursuit
Unfortunately, navigating a chronic pain condition is anything but soothing. The very act of seeking care can cause additional stress and exhaustion that exacerbates the very symptoms it aims to treat, pushing patients to their limits.
Megan Hodge, 46, has lived with chronic pain for her entire adult life. During her freshman year of college, a bout of serious illness triggered multiple debilitating conditions, including scoliosis, degenerative disc disease, postural orthostatic tachycardia syndrome, sciatica, migraines and severe irritable bowel syndrome.
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Up until 2021, she managed to live a robust life in spite of her chronic pain—traveling, running her own company, hosting dinner parties and raising her two children. Then, a significant flare left her bedridden and in excruciating pain.
For years, Hodge could not find a single point person to manage her chronic conditions—despite living in a suburb of Chicago, in close proximity to some of the nation's leading academic medical centers. Her well-meaning primary care doctor would refer her to various specialists, most of whom had months-long waiting lists. When she finally got to the appointment, the doctor would run a barrage of tests and refer her elsewhere. The information did not automatically flow from one specialist's silo to the next; each new interaction required her to recount her lengthy medical history.
Due to her IBS, she could only tolerate over-the-counter medications and spent the months between appointments in an aching daze. Unable to engage in conversation with family and friends, like many chronic pain patients, she slipped into isolation, anxiety and depression. It became increasingly difficult to manage the growing list of triggers on her own.
"I was scared to make any move," Hodge told Newsweek. "I was scared to sneeze...I was nervous to get out of bed. Anything I did could and often would trigger pain."
"I had that physical freeze, but I also had significant emotional and mental freeze and really withdrew from my life because I didn't know what else to do."
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Coping Strategies for Pain
Finally, Hodge received a life-changing referral to the Shirley Ryan AbilityLab in Chicago. Their unique pain management program relied on an interdisciplinary approach. A four-pronged team composed of a physical therapist, occupational therapist, physician and pain psychologist worked together to tackle all of Hodge's diagnoses rather than addressing one at a time.
Through group and individual sessions with the care providers, she learned practical ways to live with her pain: how to get better sleep, load the dishwasher without prompting a flare and gently stretch her nerves to mitigate pain and numbness.
Her psychologist taught her pacing strategies to conserve her energy for important events, and shared mindfulness and relaxation techniques for when she starts to feel overwhelmed. Learning not to catastrophize and give herself grace were among the greatest lessons from the program, Hodge said.
While her time at SRAL didn't completely eliminate her pain, it gave her the tools and mindset to live with it, and it helped her to manage her own and others' expectations.
"I feel fulfilled, I feel happy, I feel engaged in my life, and I'm at peace with the fact that I have this chronic health journey that I am still continuing to navigate," Hodge said.
Chronic pain specialists told Newsweek that an integrative care model, like the one at SRAL, is considered the gold standard for treatment. This method treats pain like the complex condition that it is, and allows patients to build longitudinal relationships that are crucial for nervous system regulation.
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Building trust is a core tenant of care at Confluent Health, a network of physical therapy and occupational therapy companies with more than 620 clinics around the world. Louw now serves as the company's pain science director, working alongside his wife, Dr. Colleen Louw, a certified spinal manual therapist, therapeutic pain specialist and fellow of pain science.
"Any clinician can start talking to your patient about pain," Colleen told Newsweek. "But if you don't listen and establish trust and therapeutic alliance, you're not going to get anywhere with them."
Dr. Stephen Clark, a physical therapist and Confluent Health's chief clinical officer, said that understanding a patient's social and psychological situation can lead to breakthroughs in healing. For example, one patient would present to his clinic with neck pain each year around May. He asked what was going on in her life, and eventually learned that her mom had died in May.
The anniversary of her mom's death led to changes in her sleeping, eating and exercising habits that contributed to the chronic pain, according to Clark. Helping her to understand how the complexity of that event was affecting her was essential to see improvement.
This is a common understanding amongst the nation's top chronic pain specialists and scientists. Dr. Robert Naviaux, a professor at the University of California, San Diego, popularized the cell danger response theory—when the body is exposed to threats like infections, physical or psychological trauma, the healing process is disrupted at a cellular level. Cells are unable to fully heal, leading to chronic illness and pain. The process mirrors fight-or-flight nervous system patterns, and has been linked to more than 100 common diseases, including a number of autoimmune, chronic pain and mental health conditions.
These are processes that traditional treatments—like medication and surgery—can not fully address. But the health care industry is not structured to make integrative care feasible for all patients.
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"Our health care system is transactional and often considers people in short time frames," Clark said. "What we are doing is relational over long periods of time."
Keeping Up With Demand
Clauw's research at the University of Michigan indicates that treatments like yoga, acupuncture, tai chi, physical therapy and even cognitive behavioral therapy are just as—if not more effective—than medical procedures or pills. However, most patients would have to pay out of pocket for these treatments.
"A chronic pain patient in the United States will find it easy to get a surgical procedure or an injection, because people make a lot of money doing those things," Clauw said. "It's not a guidelines issue. It's primarily a reimbursement issue."
Sivanesan runs into similar issues at Johns Hopkins. It is challenging to keep up with the demands for information from insurance companies, and for most of his patients, care is initially denied.
This challenge is not exclusive to chronic pain, but it does appear to be heightened in the specialty. Pain does not always show up on a scan or test, so it can be difficult to prove to payers.
"Because pain is so personal and subjective, it's hard to translate into the kind of measurable data that insurers often require," Sivanesan said. "That gap can make it harder for patients to access the treatments they need."
The issue is compounded by a lack of chronic pain specialists. The demand for treatment far exceeds the supply of providers. A recent study from UC Davis displayed a concerning drop in the number of anesthesiology residents applying for pain medicine fellowships. Between 2019 and 2023, there was a 45 percent decrease in applications.
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Doctors can become chronic pain specialists through a number of pathways if they specialize in anesthesiology, neurology, psychiatry or emergency medicine. Doing so requires an additional fellowship, which can tack two to three years onto a lengthy (and expensive) education, according to Dr. Sameer Awsare, an internal medicine physician who worked to reduce opioid prescriptions at The Permanente Medical Group in California.
"If you're an anesthesiologist, you can just go out and work and make a great amount of money," Awsare told Newsweek.
Much of the burden for chronic pain care falls on primary medicine physicians, many of whom are unaware of the novel treatments in the space due to the vast amount of conditions they're tasked with treating, according to Burton. At Abbott, his team has developed the Eterna neuromodulation device, which acts like a pacemaker for the spinal cord—working on the nervous system instead of the heart. The small implant acts as "noise canceling headphones" for the spinal cord to dampen distracting, distressing pain signals. Neuromodulation patients often see a "renaissance" with the device, Burton said. But it's an uphill battle to raise awareness for the treatment and get it paid for by insurance.
"There's a little baseline confusion on getting coverage for different devices," Burton said. "Then you throw newer technology in there, and we always wish coverage could come faster, easier and more widespread for patients."
Chronic pain specialists and providers expressed frustration that the system isn't keeping pace with the science. Clauw believes that if just 10 to 20 percent of expensive surgeries and injections were eliminated, the cost savings would pay for all of the integrative therapies that patients require.
"That kind of argument doesn't appear to work for third-party payers," Clauw said. "The surgical lobby and the injection lobby are extremely powerful."
A Bleak Outlook
Ultimately, the root cause of many patients' chronic pain goes unaddressed. There has been a shift toward value-based care programs and "holistic" clinics that prioritize a person's overall health rather than bandaging individual symptoms, Pickering said. Still, her team's research at Inovalon indicates that we aren't moving fast enough.
With the rise of reactionary medications like Narcan, opioid overdose deaths dropped significantly in 2024. But Inovalon's research shows that fewer than one-third of patients receive the recommended treatment within 30 days of being discharged from an opioid use disorder-related hospitalization. Despite the vast number of integrative therapies that are available, few patients that struggle with opioid addiction due to chronic pain are offered an alternative, according to Pickering.
"We're not really moving the needle when it comes to preventing or treating the disease," she said.
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The issue is poised to worsen as the population ages. Chronic pain is also increasing in younger patients as stress and sedentary lifestyles become more prevalent. Still, Louw finds this page of the pain revolution heartening. More people are taking an interest in chronic pain as discussions abound on internet forums, YouTube and social media. A new generation of clinicians is tasked with addressing the silent epidemic of chronic pain, and those that he teaches are excited to tackle the problem.
First, they'll have to overcome the field's propensity toward scalpels, scans and scripts. "On the one side we're doing really cool things," Louw said. "On the other side, oh, come on people. We can do better."
Newsweek and Statista have partnered to rank America's Leading Doctors for Pain Management. ▸ Go to Newsweek.com/aldpm-2025
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