Americans who are poor or are less educated are more likely to suffer in chronic pain than those who are more wealthy and more educated, according to new research published in the journal Pain1. The disparity between the groups has skyrocketed as high as 370% in certain categories.
Sociologist, Hanna Grol-Prokopczyk, an assistant professor of sociology at University of Buffalo and the paper’s author, reviewed 12 years of data from more than 19,000 subjects aged 51 and older who suffered in non-cancer related chronic pain.
She found that chronic pain levels are rising by period and not just by age, meaning people who were in their 60s in 2010 reported more pain than people who were in their 60s in 1998.
Grol-Prokopczyk’s groundbreaking study is among the first to look beyond either the presence or absence of chronic pain to examine instead matters of degree, asking whether the pain was mild, moderate or severe. Her research, based on the Health and Retirement Study, which asked participants if they were “often troubled with pain,” also follows the same subjects over 12 years, as opposed to most studies that illuminate a point in time.
“There are a lot of pressures right now to reduce opioid prescription,” says Grol-Prokopczyk. “In part, this study should be a reminder that many people are legitimately suffering from pain. Health care providers shouldn’t assume that someone who shows up in their office complaining of pain is just trying to get an opioid prescription.”
“We have to remember that pain is a legitimate and widespread problem,” she says.
The study also serves as an argument for investing more into research for other treatments.
“We don’t have particularly good treatments for chronic pain. If opioids are to some extent being taken off the table, it becomes even more important to find other ways of addressing this big public health problem.”
People with the least education are 80% more likely to experience chronic pain than people with the most. Looking exclusively at severe pain, subjects who didn’t finish high school are 370% more likely to experience severe chronic pain than those with graduate degrees.
“I found that people with lower levels of education and wealth don’t just have more pain, they also have more severe pain,” she says. “I also looked at pain-related disability, meaning that pain is interfering with the ability to do normal work or household activities. And again, people with less wealth and education are more likely to experience this disability.”
“If you’re looking at all pain – mild, moderate and severe combined – you do see a difference across socioeconomic groups. And other studies have shown that. But if you look at the most severe pain, which happens to be the pain most associated with disability and death, then the socioeconomically disadvantaged are much, much more likely to experience it.”
More research needs to be done to understand why pain is so unequally distributed in the population, but Grol-Prokopczyk says it’s critical to keep the high burden of pain in mind in this period of concern over the opioid epidemic.
“If we as a society decide that opioid analgesics are often too high risk as a treatment for chronic pain, then we need to invest in other effective treatments for chronic pain, and/or figure out how to prevent it in the first place,” she says.
- Hanna Grol-Prokopczyk. Sociodemographic disparities in chronic pain, based on 12-year longitudinal data. PAIN, 2017; 158 (2): 313 DOI: 10.1097/j.pain.0000000000000762