New cases of chronic pain occur more often in the United States than those of other chronic conditions, like diabetes, depression and high blood pressure, according to a study from the National Institutes of Health. The findings offer a large-scale confirmation of what previous research has shown: Chronic pain is staggeringly common in America.
Experts have known that around one-fifth of U.S. adults have chronic pain, but the new study offers a snapshot of just how many people are newly suffering each year. Researchers analyzed data from 10,415 adults who participated in two editions of an annual survey led by the Centers for Disease Control and Prevention; respondents reported how often they felt pain in the last three months, and whether that pain interfered with their daily lives.
“We’re talking about a major public health problem,” said Dr. Gregory Terman, a pain medicine specialist at the University of Washington School of Medicine and a co-author of the study.
The study shows that as more people develop new cases of chronic pain, existing patients struggle to recover. Only around 10 percent of those with chronic pain in 2019 were pain-free in 2020, which underscores just how hard it is to treat.
“It’s astronomical,” said Richard L. Nahin, the lead author of the study and the lead epidemiologist at the National Center for Complementary and Integrative Health.
And it’s possible these numbers have grown during the coronavirus pandemic, said Beth Darnall, a professor of anesthesiology, perioperative and pain medicine at Stanford School of Medicine who was not involved with the study. But a number of existing and emerging treatments can alleviate pain.
“There really are solutions, and there is help,” Dr. Darnall said. “Unfortunately, it’s just not easy to find.”
Why is chronic pain so difficult to treat?
It’s hard to pin down a singular definition of pain. The study defined people with chronic pain as those who said they had pain most days, or every day, over the previous three months. And chronic pain itself can be a disease, said Dr. Prasad Shirvalkar, an associate professor of anesthesia and neurological surgery at the University of California, San Francisco, who studies pain management. He added that it could take years for some patients to get an accurate diagnosis for conditions that cause chronic pain, and that over a third of cases occur with no clear cause.
“It’s like a fire alarm going off, but there’s no fire,” he said.
Even when doctors can diagnose conditions that cause chronic pain, many aren’t equipped to treat it. “There really is an underappreciation in the medical community about pain management,” said Dr. Michael Bottros, clinical operations chief and medical director of pain services at the Keck School of Medicine at the University of Southern California. And because pain is “nebulous” and varies from person to person, he added, it can be difficult to pinpoint the appropriate treatments.
The study also examined how pain progresses into chronic pain. Participants who experienced acute pain were more likely to develop chronic pain in the next year, with about one in six people with non-chronic pain reporting chronic pain a year later. In other words, without early intervention, experts say, pain can sometimes compound; what starts as an acute or occasional ache might worsen into a long-term problem. But not everyone has equitable access to that care, Dr. Darnall said.
How to get help for chronic pain
Experts recommend first going to a primary care doctor if you are experiencing pain that interferes with your daily life. If you’re not improving after six weeks, Dr. Bottros recommends seeking out a specialist. If you are struggling to find a chronic pain specialist, Dr. Shirvalkar recommends looking into pain centers at major universities, many of which offer telehealth appointments.
Community hospitals may also be able to offer resources. Dr. Darnall said that advocacy organizations for particular conditions, like the Marfan Foundation, can also provide educational materials and help patients find providers. Recent changes to Medicare have also expanded coverage for treating chronic pain, Dr. Nahin said.
In response to the opioid epidemic, some doctors have tried to move away from medication as the first response to treating chronic pain. It’s critical to treat chronic pain through a multimodal approach, experts said, using several therapies. A patient may go to physical therapy, for example, but also see a mental health professional for cognitive behavioral therapy. “One flavor of treatment is never going to be adequate,” Dr. Shirvalkar said.
Mental health treatment is a particularly promising, but often underused, way to address chronic pain. “A psychologist can fundamentally help reframe how people relate to their pain or even the cues that they listen to in their bodies,” Dr. Shirvalkar said.
Newer treatments are also on the horizon: Researchers are examining whether psychedelics, virtual reality treatments and brain stimulation can alleviate pain.
“It’s not a one-size-fits-all,” Dr. Darnall said. “Patients are not a monolith.”