American Pain

By Jane Farrell

New cases of chronic pain occur more often among U.S. adults than new cases of several other common conditions, including diabetes, depression, and high blood pressure, according to new research.

And among people who have chronic pain, almost two-thirds will still have it the following year. These findings come from a new analysis of National Health Interview Survey (NHIS) data by investigators from the National Center for Complementary and Integrative Health (NCCIH), Seattle Children’s Research Institute, and the University of Washington, published in May 2023 in JAMA Network Open.

Previous research has shown that about 18 percent of U.S. adults have chronic pain (pain that has lasted for three months or more). However, not much was known about how chronic pain rates have changed over time. How many people develop new cases of chronic pain each year? How many of those who have chronic pain at one time still have it a year later? And how many recover (i.e., become pain free)? This new analysis used data from the nationally representative NHIS 2019–2020 longitudinal cohort, in which about 10,000 U.S. adults were interviewed on two occasions a year apart, to find answers to these questions.

Among survey respondents who were pain free in 2019, 6.3 percent reported chronic pain in 2020, with an incidence of 52.4 cases per 1,000 persons per year (PY). Compared to other conditions for which the incidence is known for the U.S. adult population, such as diabetes (7.1 cases/1,000 PY), depression (15.9 cases per 1,000 PY), and hypertension (45.3 cases/1,000 PY), this is a high rate.

Among those who reported pain that was not chronic in 2019, 14.9 percent reported chronic pain in 2020. This is more than twice the percentage seen among those who were pain free in 2019 and suggests the importance of early management of acute or otherwise nonchronic pain to decrease the risk that it will become chronic.

According to the researchers among those who reported chronic pain in 2019, almost two-thirds (61.4 percent) also reported chronic pain a year later, showing a high persistence of this condition.

High rates of high-impact chronic pain (chronic pain that substantially limits a person’s life activities) were seen in 2020 among those who had reported either chronic pain or high-impact chronic pain in 2019.

Contrary to the assumption that chronic pain persists indefinitely, some people with chronic pain recovered. Of those who reported chronic pain in 2019, 10.4 percent had fully recovered (were pain free) in 2020.

The survey data showed some differences among population subgroups. People aged 50 or older were more likely to have chronic pain than those aged 18 to 49. Those with a college degree were less likely to have chronic pain than those without one. The incidence of chronic pain did not differ by race or Hispanic ethnicity, but Asian Americans and those of Mexican ancestry were most likely to recover from chronic pain. No gender differences were observed.

The results of this analysis point to the high disease burden of chronic pain in the U.S. adult population and the need for early management of pain to decrease the likelihood that it will become chronic.