How to move pain and symptom research from the margin to the mainstream

Pain, dyspnea, nausea, and other physical symptoms receive rather little study despite their major public health impact and the similar neural circuitry that makes these symptoms tractable therapeutic targets. Pain accounts for more than 20% of medical visits and 10% of prescription drug sales but only 0.6% of National Institutes of Health research funds. Clinical pain research remains clustered in the few clinical specialties of the founders of the field--neurology, anesthesia, cancer, and dentistry. Remarkable recent advances in basic science have not been widely applied by cardiologists, gastroenterologists, urologists, and gynecologists. Research funding in dyspnea and nausea is an order of magnitude smaller than funding in pain, despite mechanisms that may be common to all three. Political pressure from an aging population may soon influence funding agencies to train additional researchers in these areas. Academic health centers that develop the cross-disciplinary infrastructure to conduct this research will win major shares of this influx of funding and improve the diagnosis and management of many diseases.