“Stop the Stigma - Enhancing Access to Chronic Pain Treatment in Tennessee”

Imagine having chronic back or neck pain and having to drive 1-3 hours just to see someone who will treat your pain. Unfortunately, that is the reality for so many patients with chronic pain in Tennessee. There are only 109 registered pain clinics in Tennessee (TN Department of Health, 2025), or approximately 1.5 pain clinics per 100,000 residents in Tennessee. Approximately 70% of the counties in the state have zero pain clinics within their entire county (Figure 1) (Tennessee Department of Health, 2020). How can we improve access to chronic pain care in Tennessee? - We can “STOP the Stigma” surrounding chronic pain care, and require that all health care providers (HCPs), not just pain specialists, are equipped with the knowledge on how to assess and treat pain effectively.

Chronic pain affects one in 4 adults (Centers for Disease Control and Prevention [CDC], 2024), more than diabetes, cancer, and heart disease combined. However, formal pain education during HCP training is lacking, with US medical students receiving fewer than 12 hours of undefined pain training in a 4-year curriculum (Durbhakula et al., 2024).  Add to this the devastating opioid crisis, stemming partially from aggressive pharmaceutical marketing and resultant overprescribing of opioids, and is there any wonder that many clinicians now shy away from treating chronic pain? Compounding the stigma faced by physicians treating chronic pain in Tennessee are a series of laws and regulations initially intended to eliminate “pill mills” from the state. The TN Department of Health has a “high risk prescriber” identification process and “top 50 prescriber” designation, which are accompanied by licensing repercussions if not appropriately addressed (Tennessee Department of Health, 2023). All of these factors contribute to many HCPs' unwillingness to care for patients with chronic pain (Katzman & Gallagher, 2024).

However, it is essential to note that there are alternative, effective, evidence-based treatments for chronic pain that do not involve opioids. The HHS Pain Management Best Practices report emphasizes the importance of establishing a diagnosis, focusing on improvements in function, and employing a multidisciplinary approach to chronic pain care (U.S. Department of Health and Human Services [HHS], 2019). Educating all HCPs on the appropriate assessment and accurate diagnosis of the cause of pain, and then providing evidence-based non-opioid treatment options, will enhance the ability of HCPs to provide effective pain management care to patients with chronic pain. 

Stopping the Stigma surrounding chronic pain management and improving access to chronic pain care will require a paradigm shift in how pain is assessed and treated. Providing mandatory education on pain assessment and targeted, non opioid treatment will be the first step in enhancing knowledge and initiating the paradigm shift. As part of that education, it is necessary to emphasize the importance of focusing on function, rather than just a pain score. This will also help destigmatize the patient’s decision to seek care and encourage them to increase their activity levels and improve their quality of life. Finally, it is essential that HCPs know how to demonstrate authentic empathy while educating and empowering patients with chronic pain. Equipping HCPs with this knowledge and resources will reduce the hesitance and stigma associated with treating chronic pain and improve access to chronic pain care in Tennessee.