Numbers Don’t Lie: Chronic Pain Has Greater Impact on Underserved Communities

By Rebecca McKinsey

American Indians and Alaska Natives, bisexual individuals, rural residents, and people living in poverty are significantly more likely to experience chronic pain, according to recent data released by the Centers for Disease Control and Prevention (CDC).

The tenacity of advocates prompted the analysis of the data, says Cindy Steinberg, U.S. Pain Foundation’s national director of policy and advocacy.

“For us to make any progress in getting new treatments and therapies, getting insurers to cover new therapies, ensuring patients have access to them, or having doctors spend more time and not drop chronic pain patients, we need to know how prevalent chronic pain is, how it affects people’s lives, and how many people are living with it,” Steinberg shares.

Still, a deeper analysis of the types of conditions causing pain and the financial burden of that pain is needed to continue driving solutions.

The nationwide extent of chronic pain

In recent years, the extensive National Health Interview Survey asked respondents about the frequency of their pain over three months or longer, and if their pain limits their life or work activities. The CDC analyzed the answers in tandem with demographic information such as race and ethnicity, age, gender, sexual orientation, geographic location, socioeconomic status, marital status, veteran status, and more.

Almost 21% of the U.S. population—51.6 million adults—lives with chronic pain, defined as pain lasting more than three months. Of those, 17.1 million live with high-impact chronic pain that substantially restricts their ability to work or participate in daily activities. Several years’ worth of surveys have shown similar results.

“No one can tell us those numbers are not accurate,” Steinberg says. “We have multiple years of data showing the same thing.”

The data was analyzed and released by the CDC in response to efforts by advocates, including the U.S. Pain Foundation.

“Nothing happens unless advocates make it happen,” Steinberg says. “Every time you read about new research findings or new therapeutics for a disease or condition, you can be sure that hundreds of people were in front of Congress educating them on the need. We had an important role in making sure this data was analyzed and reported.”

A recent article by National Institutes of Health’s Richard Nahin in the Journal of the American Medical Association also stated that the rate of growth of chronic pain in the United States is exceeding that of other major conditions such as depression, diabetes, and hypertension.

“The numbers are staggering in themselves, but the fact that pain, particularly high-impact pain, is increasing faster than other conditions, is also really worrisome,” Steinberg says.

She adds, “When people are faced with these numbers, how can we not do something about this? We’re talking about something that affects millions upon millions of people. It’s an epidemic hiding in plain sight—policymakers and the general public hardly notice it.”

The disparities of chronic pain

The CDC data found a higher prevalence of chronic pain among populations that also face greater health care disparities, with groups experiencing chronic pain or high-impact chronic pain at the following rates:

—American Indian and Alaska Native adults: 2 times as likely as white adults

—Bisexual adults: 1.7 times as likely as straight adults

—Rural residents: 1.7 times as likely as those living in cities

—Individuals who are divorced or separated: 1.6 times as likely as those who are married

—Individuals living under the federal poverty level: 4.1 times as likely as those with incomes over four times the federal poverty level

Additionally, the data shows higher prevalence of chronic pain among older adults, women, unemployed individuals, veterans, and those with public health insurance.

“The disparities just jump out at you,” Steinberg says. “The overall chronic pain numbers are bad enough, but the unevenness in care is that much more impactful for certain populations.”

To help eliminate disparities in care for underserved populations, the report cites a need for multidisciplinary pain care, as well as improved access to more affordable and culturally responsive care.

Determining the cost of care

One of the major gaps in understanding the impact of chronic pain in the United States is its cost—in direct medical costs, disability payments, lost work, and more.

“Pain is the number-one cause of disability, and it costs billions of dollars every year,” Steinberg says. “It’s a huge problem, and it’s just not recognized.”

For politicians who want to spend less on programs like Medicare, which serves older individuals and people with disabilities—both populations that often experience chronic pain—addressing pain is a smart solution, Steinberg explains.

“If Congress puts more money into helping people feel better and giving them access to treatment, even being able to work a part-time job means they’re not relying as much on government programs,” she says. “That’s huge.”

Other gaps in chronic pain data include information about children’s chronic pain, pain among veterans, and the specific medical conditions that are causing pain.

“If we want to put money toward treatments for the worst types of pain, we don’t even know where to look,” Steinberg says. “We don’t have good data.”

Finding solutions for the often-overlooked prevalence of chronic pain in the United States has major implications.

“The number-one reason this data is important is so people recognize how much this destroys people’s lives, and how many people are affected, so that more can be done to help people with pain,” Steinberg explains. “If enough people scream about a problem, and if it’s a really prevalent problem, Congress starts to put money into funding programs to improve care, and into research to find better therapies.”