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?

Explore tools and information about chronic pain management on our separate website, Beyond Pain STL, built for both health care leaders and the public.

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

  • Why chronic pain is a psychological and physical disease
    ST. LOUIS, October 10, 2019 – Whether we accidentally stub our toe or touch a hot pan, everyone experiences pain. Most pain resolves quickly as the injury heals, but, in some cases, the pain can last beyond the time of normal healing. Chronic pain, often defined as pain exceeding three months, affects one in five…
  • Treating Chronic Pain as a Public Health Crisis
    ST. LOUIS, April, 2019 —  The chronic pain crisis is nationally recognized and locally magnified. Although sudden acute physical pain can be a life-saving alert, “chronic pain” is defined as maladaptive prolonged pain exceeding three months. According to a recent study by the Centers for Disease Control and Prevention (CDC), approximately one in five U.S….
  • New RHC Report Offers Recommendations to Improve Chronic Pain Prevention and Treatment in the St. Louis Region and State of Missouri
    ST. LOUIS, February 2, 2019 – The St. Louis Regional Health Commission (RHC) released the Chronic Pain Prevention and Treatment Policy Paper for regional stakeholders as part of its Chronic Pain Initiative, a regional effort to prevent and reduce the impact of chronic pain. The RHC’s policy paper, synthesizing national and local expertise, details four major policy recommendations:…


To learn more about the Chronic Pain Initiative, please contact Amanda Harris.