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Global burden of pain and global pain policy—creating a purposeful body of evidence

Within the past decade or so, important signals about the burden of chronic pain at population level have emerged from separate fields of work. Broadly speaking, these fields can be divided into 2 main categories—(1) national and subnational population studies that have specifically focussed on characterising the burden of chronic pain in general, or specific pain conditions such as lowback pain, and (2) global studies that characterise and rank the leading causes of death and disability at population level, conducted under the umbrella of the Global Burden of Disease Project (GBD) and by the WHO, using similar methods. An implicit shared purpose of these 2 fields is to provide evidence to inform policy responses that will lead to overall improvement in population health. The connection between these 2 fields has, to date, mainly been limited to incorporation of data from some specific national and subnational population studies of chronic pain burden into the GBD estimation methods, and use of the significant methodological advances in how to measure burden of disease. The improvements in measurement have come from the GBD over more than 2 decades by researchers and governments in individual countries to improve local studies of burden of disease. Despite the evolution of a better evidence base, there has been a lack of translation into effective and coherent global pain policy. In this article, we suggest that there is considerable potential to use local policy action research to develop an evidence base that is both more robust and policy-relevant. We argue that such an approach would further the important aim of reducing the global burden of pain. The ultimate goal is to shift the goal away from statistical accuracy of burden metrics towards applying evidence and testing policy-oriented solutions. The aims of this article are as follows: (1) to summarise recent evidence about the global burden of pain coming from the GBD about musculoskeletal pain, (2) to contextualise this evidence with insights emerging from our broader understanding of pain at a population level and as a chronic condition, and (3) the production of evidence and its relationship to global priority setting and the global health policy landscape. We then propose an agenda for expanding the body of evidence for policy and promoting its use in global health policy/prioritisation.