Chronic Pain is ‘Developing At Alarming Rates’ in the US—Here’s What You Need to Know

  • A new study found that chronic pain is more common than diabetes, hypertension, and depression.
  • Frustratingly, chronic pain is difficult to diagnose and track.
  • Experts agree that while chronic pain may be tricky to diagnose, understanding patterns around the condition are helpful in treating it on a larger scale.

woman sitting on couch suffering from backache

woman sitting on couch suffering from backache

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Chronic pain affects about one in five Americans—new research shows that chronic pain incidence rates from year to year are higher than those for diabetes, hypertension, and depression.

The JAMA Network Open study conducted a survey of about 10,400 adults between 2019 and 2020. They found that there were 52 cases of chronic pain for every 1000 people, and 12 cases of high-impact chronic pain, which refers to severe chronic pain that limits a person’s life and work activities.

The survey also showed how chronic pain changed from year to year—about 10% of people who had chronic pain in 2019 recovered in 2020. For those with nonchronic pain, about 15% had developed chronic pain within the year.

This research comes on the heels of a study published in the Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC), which found that 51.6 million Americans had chronic pain in 2021. That’s 20.9% of the adult population.

“I think this really brought to bear what we always suspected—that chronic pain is extremely common,” Afton Hassett, PsyD, associate professor of anesthesiology and director of clinical pain research at the University of Michigan Medical School, told Health.

“When you start playing with the population numbers, we’re talking about millions and millions of people,” she clarified.

Painting a Picture of Chronic Pain in the U.S.

Chronic pain has been on healthcare professionals’ and researchers’ minds for a while, explained Gregory Terman, MD, PhD, JAMA Network Open study coauthor, pain physician, and professor of anesthesiology and pain medicine at the University of Washington School of Medicine.

In 2011, the Institute of Medicine (now called the National Academy of Medicine) estimated that about 100 million Americans lived with chronic pain, Dr. Terman told Health. That number dropped thanks to a narrowed definition of chronic pain and additional research.

Researchers defined chronic pain as lasting more than three months and affecting a person every day or most days. People with high-impact chronic pain were characterized as meeting these criteria, but having such severe pain that it impacted their work or life most days.

Dr. Terman and his team sought to understand the incidence rate for chronic pain from 10,415 survey responses. In 2019, about 40% didn’t have any pain, 39% had nonchronic pain, and about 21% had chronic pain.

Looking at the data a year later, the research team found that about two-thirds of people who had chronic pain in 2019 still did in 2020. About 15% of people with nonchronic pain and about 6% of those who were pain-free developed chronic pain by 2020.

The team took note of the spike in chronic pain percentage.

“Fifty out of 1000 people had developed chronic pain from one year to the next, greater than lots of these other chronic diseases like depression or diabetes. That was the big thing,” Dr. Terman said. “It’s not just common, but it’s developing at alarming rates.”

Additionally, the study found that about 462 out of 1000 people had persistent chronic pain from 2019 to 2020. 

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Chronic Pain Is an Individual Experience

Though this study and the CDC’s report offer good estimates for how common chronic pain really is in the U.S., it can be challenging to quantify.

Even though just shy of 21% of people in the JAMA Network Open study had chronic pain—in line with the MMWR study’s findings—Hassett noted that it’s possible that chronic pain prevalence is even higher.

Neither study included participants who were in the military or in institutions, such as nursing homes. One would imagine that chronic pain would be an issue in these groups, Hassett explained.

And, just generally speaking, it can be challenging to track chronic pain.

“We don’t have tests. There’s really no way for us to truly quantify it, other than what an individual’s report is,” said Hassett.

The JAMA Network Open study didn’t find gender disparities in chronic pain. But gender norms play a large role in the conception of pain, and could account for under-reporting or under-treating. Men may see chronic pain as feminine and reject diagnoses or treatments, and women are less likely than men to have their pain believed. The same is true for racial minority groups.

Besides difficulties in the tracking of chronic pain itself, researchers also don’t know why chronic pain seems to be growing more common in the U.S. We can only speculate if more people are becoming aware of chronic pain or more willing to report it, or if lifestyle or other factors are causing more chronic pain.

The pandemic may be having an effect, Dr. Terman said—depression, anxiety, and chronic pain are all linked, he explained, so increased mental health issues may have exacerbated chronic pain.

The population is also aging, Hassett noted, which could explain why chronic pain seems to be more prevalent.

For now, however, we can only speculate as to what might be causing what seems to be an increase in the prevalence of chronic pain—no research has answered that question yet, experts agreed.

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Positive Findings and Opportunities for Treatment

Because there are still so many questions about chronic pain, it can be a frustrating or difficult diagnosis for people to receive.

However, Dr. Terman and Hassett agreed, it isn’t all bad.

The National Institutes of Health are working on an initiative called HEAL (Helping to End Addiction Long-term), which has allocated $2 billion toward research in pain management and opioid use disorders.

Plus, more new research recorded electrical signals in the brain associated with chronic pain, giving researchers a better understanding of how chronic pain works and possibly even opening the door for more personalized and accurate therapies.

“Pain is one of the most common reasons adults seek medical care in the United States," Michaela Rikard, PhD, MMWR author and health scientist in the division of overdose prevention at the CDC, told Health in a statement. "Addressing chronic pain and improving the lives of persons living with pain is a public health imperative.”

Even in Dr. Terman’s study, there were some positive findings that shouldn’t be overlooked.

“We were able to show that 10% of people who had chronic pain in the first year were actually pain-free in the second year,” he said. “What we don’t have is how they were treated. But at least here’s a little bit of hope there.”

There are treatments that can be really effective in helping people manage pain, Hassett added. Depending on a person’s level of pain, they can utilize physical therapy, medications, or other interventions such as injections, she explained. The CDC has resources for healthcare providers that's meant to make pain treatment safer and more effective, especially when it comes to using opioid therapy.

Exercise and trying to commit to a healthy lifestyle is also important, Hassett said. People may experience some pain relief from meditation, massage, yoga, spinal manipulation, or acupuncture.

“People tend to withdraw when they have chronic pain and no longer do the things that make life worth living,” Hassett said. “We have sleep disturbances and everything becomes a downward spiral. So we try to get people to get active again, to find the things that they can do, that they do enjoy doing.”

Dr. Terman concluded, “Just because you have chronic pain, doesn’t necessarily mean that you can’t become pain-free.”

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