Chronic pain is a public health crisis in the St. Louis region. In 2018, the RHC launched a chronic pain initiative to accomplish two main goals: decrease the progression of acute pain to chronic pain and improve the treatment of chronic pain in our region.

What is Chronic Pain?

When pain lasts beyond its normal point of healing and no longer serves a purpose, it is considered chronic pain. Chronic pain is often invisible; yet research shows that 1 in 5 people have it. Chronic pain keeps people from going to work and doing other things they need to do. One study shows that it is costing our national economy about 600 billion dollars every year.

Interested in learning more about chronic pain?

Priority Areas

The chronic pain initiative aims to improve the prevention and management of chronic pain in the St. Louis region with three main strategies, outlined below with examples of the work. 

Policy Reform

The RHC drafted a policy paper with regional and statewide recommendations on chronic pain management, based on national strategies, 200 peer-reviewed articles, and 35 stakeholder interviews. 

Clinical Improvement

  • In April 2020, a new specialty care triage referral process for Washington University was implemented to expand access and decrease wait times for pain services for all Gateway to Better Health patients.
  • In October 2019, Gateway to Better Health requested the addition of a physical function improvement benefit that would fund and integrate physical therapy, chiropractic services, and occupational therapy into the community health centers. Read the full benefit request.

Education for Providers and Patients

  • The RHC launched an educational campaign, in collaboration with Alive and Well Communities, for Missouri providers and patients to recognize the role of trauma and emotional pain in chronic physical pain.
  • Online materials offer opportunities for patients and providers to learn more about chronic pain management and prevention. Visit the RHC’s chronic pain website, Beyond Pain STL, which compiles tools and information about chronic pain management for both the public and health care providers.


Due to the continuous high volume of orthopedic specialty care referrals for the Gateway to Better Health program since its inception in 2012, the RHC called for an orthopedic referral analysis in August 2016. The corresponding report, Orthopedic Referral Study: Assessment of Current Practices and Recommendations Regarding the Care of Patients with Musculoskeletal Problems, was approved by the RHC in August 2017. Key findings included: the high prevalence of musculoskeletal chronic pain and the multifaceted opportunities to improve chronic pain treatment and prevention for patients in the St. Louis safety network.

Additionally, the 2018 Gateway to Better Health Patient Satisfaction Survey revealed:

  • More than half of respondents suffered from chronic pain, which is greater than twice the national average rate of chronic pain among U.S. adults, according to the CDC.
  • Of the Gateway patients with chronic pain, approximately two-thirds experience pain in multiple locations, and another two-thirds report that their pain affects their ability to seek or maintain employment.

Chronic Pain Initiative in the Media

  • New White Paper Available!
    Addressing Chronic Pain: Integrating Physical Function Services into Community Health Centers
  • New RHC Chronic Pain Workbook
    New RHC Chronic Pain Workbook Offers Information and Tools to Navigate the Intersection of Physical Pain and Mental Health
    The State of Missouri received approval to provide physical function services beginning January 1, 2021, to its “Gateway to Better Health” (Gateway) Pilot Program population from the Centers for Medicare and Medicaid Services (CMS). In addition to current services, the Gateway network of community primary care providers can now offer physical therapy, chiropractic, and occupational … Read more
  • Logan University partners with St. Louis County to deliver chiropractic care
    ST. LOUIS, November 24, 2020 – Chesterfield-based Logan University, a private chiropractic and health science school, is teaming up with the St. Louis County Department of Public Health to advance chiropractic care for residents. According to a release, Logan doctors will work with the health care team at the county’s John C. Murphy Health Center … Read more
  • NEW resource for patient and provider chronic pain management: Visit today!
    The St. Louis Regional Health Commission (RHC) released a new website called as part of its Chronic Pain Initiative, a regional effort to prevent and reduce the impact of chronic pain. Beyond Pain STL offers tools, information, and videos to our community: people with chronic pain, medical providers, and advocates. The evidence is clear: non-pharmacologic, … Read more