Chronic Pain Prevalence Remains Among 1 in 5 US Adults

S. Michaela Rikard, PhD

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The burden of chronic pain among US adults has appeared to stagnate since 2016—and the prevalence of high-impact chronic pain that which impairs daily activities has decreased over the same time period, according to new data from the Centers for Disease Control and Prevention (CDC).

In an analysis from CDC investigators led by S. Michaela Rikard, PhD, of the CDC’s division of overdose prevention at the National Center for Injury Prevention and Control, the prevalence of chronic pain among US adults in 2021 was observed to remain near its reported 20.4% in 2016, while high-impact chronic pain decreased from 8.0% to 6.9%. Though the latter rate is progressing toward the Department of Health and Human Services (HHS) Healthy People 2030 objective of 6.4%, the current rate of overall chronic pain among US adults is now disparately impacting minority groups including non-Hispanic American Indian or Alaska Native adults.

Chronic pain, defined as pain lasting ≥3 months, was estimated to impact 50 million US adults in 2016—approximately 1 in every 5 individuals. The investigators stressed it remains an “imperative” to proactively address chronic pain and its effect on US livelihoods, health care costs and lost productivity.

“Population research objectives in the National Pain Strategy, which was released in 2016 by the Interagency Pain Research Coordinating Committee, call for more precise estimates of the prevalence of chronic pain and high-impact chronic pain (i.e., chronic pain that results in substantial restriction to daily activities) in the general population and within various population groups to guide efforts to reduce the impact of chronic pain,” they wrote.

Rikard and colleagues assessed 2019 – 2021 data from the National Health Interview Survey (NHIS) to estimate national prevalence of chronic and high-impact pain in both the overall US population and sub-populations based on demographic, geographic, socioeconomic and health statuses including sex, age, race, ethnicity, sexual orientation, marital and veteran status and country nativity.

They observed that from chronic pain prevalence in US adults ranged from 20.5% to 21.8% from 2019 – 2021, while high-impact chronic pain ranged from 6.9% to 7.8%. An estimated 51.6 million US adults experienced chronic pain in 2021, and 17.1 million experienced high-impact chronic pain.

Each of the following subpopulations were at notably greater risk of chronic pain in the national estimate:

• American Indian or Alaska Native adults (12.8%)
• Adults with a family income under the federal poverty level (14.4%)
• Adults who identified as bisexual (32.9%)
• Adults who were divorced or separated (29.6%, 10.1%)
• Adults born in the US (21.6%)

Among all the observed chronic medical conditions in the NHIS, adults with a history of encephalomyelitis or chronic fatigue syndrome (70.0%) and dementia (54.9%) reported the greatest prevalence of chronic pain.

Though Rikard and colleagues acknowledged a stagnation in chronic pain prevalence versus 2014, as well as a promising decrease in high-impact chronic pain, they noted the key disparities in subpopulation chronic pain burden elucidate public health-level needs in further curbing the country’s pain epidemic.

“CDC’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pain provides recommendations to promote a multimodal and multidisciplinary approach to pain management and implementation strategies to reduce disparities in pain management care,” investigators wrote. “In addition, policies and programs that address primary injury prevention, improved access to affordable, culturally responsive health care, and more effective pain management therapies can mitigate the burden of chronic pain.”

They expressed hope the new cohort analysis may inform policymakers, clinicians, and fellow investigators in the continued pursuit of chronic pain intervention and management in the US adult population.

References

1. Rikard SM, Strahan AE, Schmit KM, Guy GP Jr. Chronic Pain Among Adults - United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72(15):379-385. Published 2023 Apr 14. doi:10.15585/mmwr.mm7215a1