The Alarming Increase of Chronic Pain Cases in the US

Research shows that chronic pain affects about one in five Americans, with incidence rates 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, and found that there were 52 cases of chronic pain and 12 cases of high-impact chronic pain for every 1000 people. High-impact chronic pain refers to severe chronic pain that limits a person’s life and work activities.

The survey also showed that chronic pain incidence rates changed from year to year, with about 10% of people who had chronic pain in 2019 recovering in 2020. For those with nonchronic pain, about 15% developed chronic pain within the year. The Centers for Disease Control and Prevention (CDC) found that 51.6 million Americans suffered from chronic pain in 2021, which is 20.9% of the adult population.

"I think this really brought to bear what we always suspected—that chronic pain is extremely common,” says Afton Hassett, PsyD, the director of clinical pain research at the University of Michigan Medical School. “When you start playing with the population numbers, we’re talking about millions and millions of people.”

For chronic pain to be recognized, it should last more than three months and affect a person every day or most days. People with high-impact chronic pain meet these criteria but have such severe pain that it impacts their work or life most days.

The incidence rate for chronic pain was studied by Dr. Gregory Terman and his team through 10,415 survey responses. About 40% didn't have any pain, 39% had nonchronic pain and about 21% had chronic pain. A year later, the research team found that about two-thirds of people who had chronic pain in 2019 still had it 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 noted the spike in chronic pain percentage.

Even though just shy of 21% of people in the JAMA Network Open study had chronic pain, Hassett notes 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.

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.

Researchers don’t know why chronic pain seems to be growing more common in the U.S. It is only speculated 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.

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.”