Thursday, May 3, 2012

New Survey: Half of U.S. Adults Have Chronic Pain

Chronic Pain According to a just-released large survey from the Gallup organization, nearly half (47%) of American adults reported having some type of chronic pain in 2011, which would amount to at least 111 million persons. This incredible prevalence of pain appears to confirm earlier estimates by the U.S. Institute of Medicine; although, despite the dissent of some doubters, the numbers actually may be underestimates.

During 2011, an ongoing Gallup-Healthways survey randomly contacted more than 353,000 U.S. adults, aged 18 and older, via telephone. The survey included persons living in all 50 states and the District of Columbia, and calls were made to both landline telephones and cellular phones. Respondents were asked if they had a neck or back condition, a knee or leg condition, or another condition that caused recurring pain in the last 12 months [full report here].

Overall average responses for each of the 3 recurring conditions were: neck or back, 31%; knee or leg, 26%; and other, 18% — participants could respond in multiple categories. In sum, 47% of adult Americans reported having at least one of the 3 types of chronic pain measured in the survey, including 7% who reported all 3 types. The reported margin of error in the survey was ±1.0% at a 95% confidence level.

According to U.S. census data [here], the population in 2011 reached roughly 311 million persons, of whom approximately 76% were aged 18 and older; so, about 111 million persons would have experienced chronic (recurring) pain to some extent during that year. It should be noted, however, that this number does not include children under age 18, and the surveyors did not contact institutionalize individuals in healthcare facilities or prisons.

Of some interest, examining age differences in 5-year increments, the Gallup survey found that chronic pain prevalence rates for the 3 categories generally increase rapidly from about ages 25 to 60, after which reports of chronic pain increase only slightly or actually decline into later years. [See Graph below, click on image to enlarge.]

Gallup-ChronicPainAs noted above, a key finding of the report was that, beginning at around age 60, rates of self-reported chronic pain level off and do not significantly increase further, even as Americans move into their 70s, 80s, and 90s. The report authors believe the prevalence would likely continue to compound into old age, except for mortality rates associated with chronic pain conditions. For example, they note, nearly half of people with arthritis have one additional comorbid condition such as heart disease, chronic respiratory conditions, diabetes, or stroke. It is possible that elderly persons surviving into their 70s and 80s are typically less likely to have such chronic pain conditions and comorbid disease, but this needs verification.

Two other findings from the survey are of importance:

  • Americans with lower annual income (<$36,000/yr) were much more likely to report having chronic pain conditions than those in higher income brackets. There was an 11% difference in reports of neck and back pain between lower- and higher-income Americans (>$90,000/yr), a 13% difference for knee and leg pain, and a 10% difference for other recurring pain conditions.

    One possible reason for these variances, suggested in the report, is that lower-income individuals are less likely to have adequate health insurance, if any, and, therefore, are unable to afford proper medical care for their chronic pain conditions. Another reason could be that lower-income Americans may be more likely to work in manual labor occupations that incur added strain and pain.

  • Secondly, the survey found that overweight or obese respondents were much more likely to report a chronic pain condition than those who maintained normal weight. Previous large surveys from the Gallup organization [here] had found both an increasing trend in obesity among Americans (indicated by BMI, or body mass index) and a corresponding relationship with chronic pain conditions.

    One likely reason is that overweight and obese individuals place extra pressure on weight-bearing joints, such as the knees and hips, which may lead to chronic pain conditions like arthritis. However, another interesting finding in the present survey is that there was a slight uptick in chronic pain reports among underweight persons across all 3 categories, compared with people of normal weight, which seems worthy of further study.

COMMENTARY: This was a large-scale, randomized survey conducted by a well-established research group. The Gallup organization has a reputation for high-quality polling on various issues spanning more than 75 years; although, this fact alone does not necessarily endorse the accuracy and reliability of this particular survey on pain.

Apparently, questions relating to recurrent pain were but one part of a much larger survey; so, it is disappointing that more specifics are not reported on the quality, severity, and duration of pain reported in the 3 broad categories. “Recurring” pain during a 12-month period can have different interpretations, ranging from, say, once per month to daily. It would be helpful to know more about how questions were asked and the data were collected in classifying pain as being chronic.

Those concerns aside, the present survey outcomes are highly consistent with the Relieving Pain in America report from the U.S. Institute of Medicine (IOM) released last summer. The IOM report initially claimed that 116 million Americans suffer chronic pain — excluding children and institutionalized adults — and this was later revised downward to 100 million to correct a mathematical miscalculation [see discussion in Pain-Topics UPDATE here].

The IOM estimate was based on a single, multinational survey published in 2008 that included face-to-face interviews with roughly 42,000 adults in 17 countries, including the United States. The overall prevalence of chronic pain was 43.4%, and it was 43% in the U.S. alone. This was a good-quality survey, but included a much smaller sample than the present Gallup investigation, which found the prevalence to be 47%, or 111 million adults in 2011.

The original IOM estimate might have been closer to the mark; however, at the very least, the Gallup survey provides confirmation that well in excess of 100 million Americans suffer chronic pain of some type and to some extent. If children and institutionalized adults are added, the numbers could be considerably higher.

Some naysayers have found such high prevalence rates of chronic pain to be incredulous, and government agencies like the Centers for Disease Control and Prevention (CDC) have largely been mum on the issue; focusing instead on concerns about prescription pain relievers and a so-called epidemic of addiction and overdose deaths. Yet, most clearly, there is a true epidemic of pain in America, and worldwide. This appears to be exacerbated by select population demographics — eg, excess weight, poverty — and inadequate treatment for these conditions. As usual, readers’ comments are welcomed.

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