Chronic pain surged in U.S. adults after pandemic, UB study finds

There was a dramatic surge in chronic pain prevalence among American adults three years after the World Health Organization declared the novel coronavirus a global pandemic, according to a study co-written by a UB researcher.

Although pain prevalence remained stable during the pandemic, and by some measures even declined slightly from 2019 to 2021, researchers found a startling spike in 2023.

Roughly 20% of Americans, about 50 million people, reported chronic pain prevalence — pain on most days or every day in the past three months — in 2019. That already unacceptably high prevalence climbed to over 24% by 2023, a jump representing an additional 10 million people with pain, bringing the total number of people affected to over 60 million.

“This is the highest prevalence of chronic pain ever recorded in the U.S.,” says Hanna Grol-Prokopczyk, associate professor of sociology, College of Arts and Sciences, and co-author of the research, which was led by Anna Zajacova, a sociology professor at the University of Western Ontario.

Similarly, high-impact chronic pain (HICP) rose from 7.5% in 2019 to 8.5% by 2023, an increase that means that more than 21 million Americans are now living with HICP, the most debilitating form of chronic pain, which impacts daily activities from socializing to self-care.

In addition to chronic pain and HICP, the research team, which included Richard Nahin, senior epidemiologist at the National Institutes of Health, also studied six types of severe site-specific pain, including back/neck pain and headaches/migraines. All showed increases in prevalence except for tooth/jaw pain.

The 2023 surge was observed in all age, gender and racial/ethnic groups, in all educational categories and in both rural and urban areas.

But why did pain spike after, not during, the pandemic, a time when pain researchers expected to see increases?

Policies put in place during the pandemic are one possible explanation, according to the research team. Expanded unemployment benefits and eviction moratoriums eased financial strains. Remote work and its accompanying reduction in commuting, meantime, lessened physical demands, while offering more flexibility for self-care.

The findings, published in the journal PAIN, have relevance for researchers, clinicians and policymakers trying to better understand the effects of large-scale disruptions to public health.

“The big question is why we saw this substantial increase in pain prevalence after the pandemic. We examined the role of long COVID and found that it explained about 13% of the increase,” Grol-Prokopczyk says. “None of the other measures we examined — including changes in income or physical health conditions — explained the increase.

“We speculate that abrupt termination of pandemic-era policies, such as remote work arrangements and expanded unemployment benefits, may have played a role,” she adds. “Declines in non-COVID-19-related health care during the pandemic may also have had a lagged effect on the development of chronic pain by 2023.”

The researchers relied on data collected in 2019, 2021 and 2023 from more than 90,000 adults as part of the National Health Interview Survey. (Key variables were not collected in 2020 and 2022.) The study is the first nationally representative analysis of pain trends prior to, during and after the COVID-19 pandemic.

“These findings,” Grol-Prokopczyk says, “highlight the importance of expanded epidemiological and clinical research on chronic pain to better understand population-level drivers of pain (and the time scale at which they operate), and to improve national pain prevention and treatment efforts for the many Americans at risk of or affected by pain.”