Pakistan still has no "clear path" to defeat militants on its soil, a new White House has said.
The report also said the Afghan Taliban had begun targeting civilian targets in recent months and that "heavy fighting" was expected this spring.
Pakistan has come under increasing criticism from the West for its support of al-Qaeda and Taliban militants.
In January, a US strategic review of the war said Pakistan must do more to defeat the militants.
Pakistan has repeatedly rejected claims that it is dragging its feet in the fight against militancy. It says that it works hard with the US in the "war against terror".
'Vexing'
The White House report said that in spite of "tremendous human sacrifices" made by Pakistani security forces and increased military co-operation between Pakistan and US in the last three months, the fight against militancy was making little progress.
It cites the example of an operation to clear insurgents from Mohmand and Bajaur tribal agencies that began in January - the third time in two years - and has been hobbled by resistance from the militants, bad weather and the need to settle internally displaced people.
"What remains vexing is the lack of any indication of 'hold' and 'build' planning or staging efforts to complement ongoing clearing operations," the report said.
"As such there remains no clear path to defeating the insurgency in Pakistan, despite the unprecedented and sustained deployment of over 147,000 forces."
The White House report says that Pakistan and Afghanistan needed to co-operate more to destroy insurgent havens on both sides of the border.
The report also warned that the rising number of suicide attacks in Afghanistan in recent months pointed to the beginning of this year's "fighting season" in the country.
It also appeared to suggest a shift in Taliban's tactics against "softer government and civilian targets".
"The shift in the Taliban's greater use of murder and intimidation tactics reflects an insurgency under the pressure of a more substantive coalition military campaign," the report said.
"That said, there are also indications that the Taliban remains confident of its strategy and resources, and heavy fighting is expected to resume this spring."
The US has long expressed frustration about Pakistan's reluctance to take on militants in the tribal areas.
In a report in October, the White House accused the Pakistani military of continuing to avoid military engagements that would put it in direct conflict with Afghan Taliban or al-Qaeda forces in North Waziristan.
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