Chronic Pain in America: Who is at Greatest Risk?

Results: Prevalence of Chronic Pain in the US, 2021:

• Almost 52 million US adults (20.9% of the population) reported chronic pain, defined as pain occurring on most or every day for >3 months.
• 17.1 million adults (approximately 6.9%) reported having high-impact pain, ie, chronic pain that results in substantial restriction to daily activities.

Results: Groups Reporting Highest Rates of Chronic Pain: Consistent with previous studies, the prevalence of both chronic pain and high-impact chronic pain were highest among:

• Women
• Older adults
• Adults who were currently unemployed but previously worked
• Those with public health insurance
• Veterans
• Adults living in poverty
• Those residing in nonmetropolitan areas

Results: Experience of Pain Differed Across Populations When Compared:

• The rate of high-impact chronic pain among American Indians and Native Alaskans (AI/AN) was nearly 2x as high as among non-Hispanic White and Black adults and 6x as high as among non-Hispanic Asian adults.
• Rates of chronic pain and high-impact chronic pain among divorced or separated adults was nearly 2x as high as among those who were married.
• Rates of chronic pain among those identifying as bisexual were higher than among those who identified as straight or as gay or lesbian.

Results: Chronic Medical Conditions: The prevalence of chronic pain and high-impact chronic pain was highest among adults with what survey authors called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)* and those with dementia.

* Use of this term indicates that an etiology for the condition has been identified which it has not.

Conclusions: Demographic, Socioeconomic Status:

• Groups that are of lower income are more likely to have jobs requiring physical labor and have less access to medical care. They are also more likely to experience and be less likely to be treated for conditions that can cause chronic pain such as diabetes, obesity, and cardiovascular disorders.
• AI/AN adults, which the survey found to have higher levels of pain than other racial groups, fit all these categories.

Conclusions: Marital Status:

• It is possible that being unmarried or separated requires people now living alone to perform more daily taskswhich could exacerbate the pain or that the lack of social supports could make coping with the pain more difficult.
• It is also possible that the chronic pain may have affected interpersonal relationships so that in some cases pain may have caused the disruptions rather than resulting from them.

Conclusions: Sexual Identity:

• It remains unclear why those who identify as bisexual are more likely to report chronic pain than are other groups, including those who identify as gay and lesbian.
• Whether it has to do with access to care or other factors needs to be determined.

Conclusions: Medical Conditions:

• The higher prevalence of pain among adults with dementia fits with the correlation between older age and chronic pain.
• Unfortunately, many studies have shown that those with cognitive impairment, such as dementia, receive poor pain management, a problem that may increase the impact of pain on their lives.

Conclusions: Chronic Pain and ME/CFS:

• The association between ME/CFS makes sense. There are many who believe this syndrome may be similar to, if not the same condition as fibromyalgia, with the difference being the major presenting symptom for each: fatigue in one and pain in the other.
• There is also a high degree of association between depression and chronic pain.
• It is possible at least some of those who self-diagnosis with ME/CFS are actually suffering from depression, which can cause similar symptoms, but refuse to accept this out of a belief it means their pain won't be considered "real." Similarly, physicians might misdiagnosis depression as ME/CFS so as not to be appearing to dismiss the pain.

Conclusions: Key Findings:

• The findings of greatest importance are how many adults experience chronic pain and chronic high-impact pain and for whom it interferes with their lives.
• Prior studies have found the management of chronic pain remains poor for many people, even those who are financially secure, have no problem accessing medical care, and have stable lives much less those without these benefits.
• This study highlights the groups that deserve special attention.

Conclusions: Future Research:

• Only future surveys will be able to address the impact of the COVID-19 pandemic on the prevalence of chronic pain.
• The current report captures some elements of this but how extensive an effect long COVID will have has yet to be answered, even as it has already been associated with the development of chronic pain.