dr. maixner, and then ms. veasley and dr. sarno down here on the end. there you go. we welcome dr. william maixner. dr. maixner is the director for the center of neurosensory disorders for the university of north carolina at chapel hill. dr. maixner comes to us today with specific experience in pain management research. he has developed an oral facial pain management program at chapel hill. kristen veasley the director of the national vulvodynia association. recently she was appointed to search on the pain research coordinating committee at nih. the committee was created to coordinate pain research facilities across the federal government. and next we have dr. john sarno, a professor of rehabilitation medicine at new york university medical center and practitioner at rusk institute of rehabilitative medicine. dr. sarno, the author of four books on pain will share his work with respect to treating chronic pain. so i thank all of you for coming here. your statements will be made a part of the record in their entirety. and i ask you if you could sum up in five or seven minutes. there i

dr. maixner, y'all have discussed doctor shopping. i know dr. maixner has. and sometimes this is a barrier to properly treating patients with chronic pain. can -- on average, how many doctors does a patient suffering from chronic pain see before getting a proper diagnosis? do you have any estimates on the cost of this -- the numbers of different doctors that a patient might go to? what does that cost the health care system? and is it because the patient doesn't get the response or they're still in pain that they feel they have to go to another doctor, or are they also looking for more medication? >> senator, i think that's an important question. i wonder if i could just slightly broaden it if you would be willing? >> please. >> clearly, what we know today and what you have heard is that we're spending as a nation between 565 to $630 billion a year on pain. and that over 116 million individuals are affected by it. many of those individuals don't have access to health care as we would like them to be able to. and even though we have some wonderful centers and

dr. maixner. i'll yield to senator whitehouse for further elaboration on the next witness. >> thank you, i'd also like to make a brief comment. >> sure. >> first of all, thanking you for holding a hearing on this important topic, the costs that come with chronic pain are enormous, and not just cost measured in dollars, but they are human costs measured in quality of life. as rhode island's attorney general, i brought together a group of health care stake holders to look into problems we were facing and making pain management a routine part of patient care. our work centered on simple things like making pain a fifth vital sign recorded by the medical establishment, and it was memorial hospital the first to take the step, and other rhode island hospitals since followed on. promoting awareness and education and nearing end of life, and both cross providers and parties have to be a fundamental strategy to improve care, and brown university had done a study showing that the majority of families with a

dr. maixner. senator whitehouse? >> thank you, chairman. if you don't mind, i would also like to make a brief comment, first of all thanking you for holding a hearing on this important topic. the costs that come with chronic pain are enormous, and they're not just health care costs measured in dollars. they're also human costs measured in quality of life. as rhode island's attorney general, i brought together a group of health care stakeholders to look into problems we were facing. in making pain management a routine part of patient care. our work centered on simple things like making pain a fifth vital sign, recorded by the medical establishment, if my memory serves it was memorial hospital the take that first stop, and other hospitals have since followed on. promoting an awareness and education about pain management particularly for patients nearing the end of life, both across providers and patients has to be a fundamental part of any strategy to improving pain care. we worked with joan tino of brown university who had done a study showi