Pain among US adults before, during, and after the COVID-19 pandemic
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Importance
Chronic pain is a major public-health problem in the US. The COVID-19 pandemic led to widespread disruptions in the US. It remains unclear, however, how medical and societal changes during this period affected national chronic pain prevalence, a key dimension of population health.
Objective
To determine prevalence of chronic pain (CP) and high-impact chronic pain (HICP) before, during, and after COVID-19 pandemic and explore reasons driving the trends
Methods
We use data from the 2019, 2021, and 2023 National Health Interview Survey (NHIS), a multi-wave cross-sectional survey. Nationally representative sample of non-institutionalized civilian US population age 18 and older (n=88,469). Year of interview is the exposure. All regression models control for age and sex; some models include additional 19 covariates (demographics, socioeconomic status, health behaviors, health conditions, mental health, and health insurance type); analyses also explore the role of COVID and long COVID. Primary outcomes were the prevalence of CP and HICP measured via widely-used validated measures. CP was based on the question “In the past 3 months, how often did you have pain? Would you say never, some days, most days, or every day?”; CP is defined as pain on most days or every day. HICP was defined as chronic pain that limited life or work activities on most days or every day (versus never or some days).
Results
Chronic pain prevalence was 20.6% (19.9-21.2%) in 2019, 20.9% (20.3-21.6%) in 2021, and 24.3% (23.7-25.0%) in 2023. HICP also increased from 7.5% (7.1-7.8%) in 2019, to 8.5% (8.1-8.9%) in 2023, after a decline to 6.9% (6.6-7.3%) in 2021. The 2023 increases occurred in all examined body sites except for dental pain. COVID and long COVID had a modest role in the population-wide pain increases, the causes of which remain unclear.
Conclusions and Relevance
Pain among US adults was high before the pandemic but surged dramatically since. In 2023, an unprecedented 60 million Americans had chronic pain and 21 million had high-impact chronic pain.
