Chronic Pain Is Rising, and It’s Not Clear Why

More Americans are living with pain now, CDC data show

https://www.medpagetoday.com/neurology/painmanagement/113149

A new CDC report indicated that the percentage of Americans with chronic pain rose considerably in recent years, and it’s not clear why.

In 2023, 24.3% of U.S. adults had chronic pain lasting 3 months or longer. In 2016, that figure was 20.4% and in 2021, it was 20.9%

The numbers came from the National Health Interview Survey (NHIS), a cross-sectional poll conducted annually by the CDC’s National Center for Health Statistics. The NHIS methodology and questions have not changed, the CDC said.

“What is clear is we have an astounding and growing public health crisis of chronic pain,” observed Sean Mackey, MD, PhD, of Stanford School of Medicine in Palo Alto, California, who co-authored the CDC’s analysis of chronic pain prevalence in 2016.

“This crisis touches everyone and requires a broader public health approach to reverse this concerning trend,” he noted.

Aging and Other Risk Factors

Several reasons may account for rising chronic pain percentages, Mackey said. “Chronic pain prevalence increases with age,” he told MedPage Today. “The U.S. population has a growing proportion of older adults, which may contribute to higher rates of chronic pain overall.”

The COVID-19 pandemic may have played a role, he added. “The pandemic led to delays in healthcare access and surgeries, increased sedentary lifestyles, and heightened mental health challenges such as anxiety and depression, all of which are associated with chronic pain,” Mackey noted. “Even outside COVID, we appear to have a more highly stressed population.”

Economic disparities, reduced access to healthcare, and environmental factors in rural or non-metropolitan areas also may have exacerbated chronic pain rates, he said.

An overall decline in health in the U.S. could be another factor, suggested Beth Darnall, PhD, also of the Stanford School of Medicine. Type 2 diabetes rates are increasing and obesity is widespread, she indicated. “There is a clear connection between obesity and chronic pain, and it is multifactorial,” she told MedPage Today.

It’s not just diabetes and obesity, Darnall emphasized: many chronic disease rate are accelerating, and most of these diseases are associated with different types of chronic pain.

Changes in Pain Management

The U.S. opioid crisis also rose to the forefront between 2016 and 2023, and changes in pain management   guidelines followed.

“Efforts to reduce opioid prescriptions may have led to inadequate pain management for some individuals, potentially increasing reports of chronic and high-impact pain,” Mackey said. “We have been concerned about this unintended consequence for a long time.”

The new CDC numbers reflect the reality that many patients are facing, noted Charles Argoff, MD, of Albany Medical College in New York, who is president of the American Academy of Pain Medicine (AAPM), and Antje Barreveld, MD, of Newton-Wellesley Hospital in Newton, Massachusetts, who is AAPM’s president-elect.

“Those with the greatest need for chronic pain care too often do not have access to the type of pain management care that is most likely to help,” wrote Argoff and Barreveld in an email to MedPage Today.

“We need to leverage technology, including telemedicine and other approaches, to be able to offer team-based care to all those who can benefit from it,” they added.

“We will continue to see higher rates of chronic pain in our population unless we change how we deliver optimal care to all people. This will require a coordinated effort across not only all medical specialties, but also all payers,” Argoff and Barreveld continued. “Pain medicine specialists comprise less than 1% of the medical workforce so we need to truly work as a team with others if we are going to be able to address this chronic pain crisis effectively.”

Some providers feel unequipped to treat pain despite the availability of many effective treatments, they pointed out. “A fear of opioids and misconceptions about what else besides medications can help reduce pain also has led to many healthcare providers being afraid to treat chronic pain.”

Better Treatment Needed

“We need better comprehensive treatment for acute and chronic pain alike,” noted Darnall. “If we treat acute pain better, we will have fewer people transitioning to the chronic pain state.”

The new CDC data also showed that 8.5% of U.S. adults had high-impact chronic pain — pain severe enough to restrict daily activities.

“Currently, people with high-impact chronic pain are over-medicalized with costly and often risky treatments that offer limited benefit, while we undertreat with the lowest-risk behavioral treatments. The idea isn’t to prevent medical care, but to ensure access to low-risk evidence-based behavioral options for symptom management,” Darnall said.

“Encouragingly, we see a clear trend toward offering behavioral treatments as standard care — meaning everyone gets them, with no screening applied,” she added.

Argoff and Barreveld emphasized the importance of “appropriate care to all patients experiencing chronic pain, whoever they are and wherever they live.”

“We must work together to combat obstacles, like the fact that insurers are more likely to pay for a pill or invasive procedure than for comprehensive multidisciplinary team-based care, which is often more effective,” they said.

Filed under: General Problems