Pain Among US Adults Before, During, and After the COVID-19 Pandemic: A Repeated Cross-Sectional Study using the 2019-2023 National Health Interview Survey

Importance

Chronic pain (CP) is a major public health problem in the US. The COVID-19 pandemic led to widespread disruptions in the US and it is important to monitor changes in pain during and after the pandemic.

Objective

To determine prevalence of chronic pain (CP) and high-impact chronic pain (HICP) before, during, and after the COVID-19 pandemic and identify potential contributing factors.

Methods

We analyze a nationally representative sample of 88,469 community-dwelling Americans aged 18 and older from three cross-sectional waves of the National Health Interview Survey before (2019), during (2021), and after (2023) the COVID-19 pandemic.

Year of interview is the exposure. All regression models control for age and sex; fully controlled models include 19 additional covariates (demographics, socioeconomic status, health behaviors, health conditions, mental health, and health insurance type); analyses also explore the role of long COVID. Outcomes are CP and HICP using measures proposed by the US National Pain Strategy; we also present findings for six site-specific pain measures.

Results

Between 2019 and 2023, CP and HICP prevalence increased by 18% and 13%, respectively. Specifically, CP prevalence was 20.6% (95%CI: 19.9-21.2%) in 2019, 20.9%(20.3-21.6%) in 2021, and 24.3% (23.7-25.0%) in 2023. HICP prevalence declined from 7.5% (7.1-7.8%) in 2019 to 6.9% (6.6-7.3%) in 2021, before rising sharply to 8.5% (8.1-8.9%) in 2023. The increases occurred in all examined body sites except for tooth/jaw pain, and in all major population groups. Approximately 13% of the increase in CP and HICP was attributable to long COVID.

Conclusions and Relevance

Pain among US adults was high before and during the pandemic but has surged substantially since. In 2023, an unprecedented 60 million Americans had chronic pain and 21 million had high-impact chronic pain.