People are developing new cases of chronic pain at higher rates than new diagnoses of diabetes, depression or high blood pressure, according to a study published Tuesday.
The research, which appears in the journal JAMA Network Open, relied on data from an annual survey conducted by the National Institutes of Health, which asked adults how often they experienced pain in the prior three months. Chronic pain was defined as pain on most days or every day during that window.
The researchers compared the responses of more than 10,000 people in 2019 and 2020. To determine the rate of new cases that developed over that period, they used a metric called person-years, which accounts for the number of people in the study and the amount of time between people’s survey responses, since not everyone responded at the same intervals.
The researchers identified around 52 new cases of chronic pain per 1,000 person-years. That was higher than the rate for high blood pressure — 45 new cases per 1,000 person-years — and far higher than the rates of new depression and diabetes cases.
Of those without any pain in 2019, 6.3% reported new chronic pain in 2020, according to the study.
“What we’re finding is, to nobody’s surprise, we have an astounding problem of pre-existing chronic pain in this country and a huge amount of people who are developing chronic pain as each year goes by,” said Dr. Sean Mackey, chief of pain medicine at Stanford University School of Medicine, who wasn’t involved in the research.
In 2019, around 21% of the more than 10,000 adults who participated in the NIH study reported chronic pain. By contrast, nearly 19% of U.S. adults had depression, while rates of diabetes, heart disease and asthma were below 10%, according to the Centers for Disease Control and Prevention.
High blood pressure was more common than chronic pain: Around 48% of adults had hypertension, on average, from 2017 to 2020.
“Chronic pain can be a disease in and of its own right,” Mackey said.
He added that people often experience chronic pain across multiple parts of the body, but low-back pain is the most common, followed by headache and neck pain.
The new study found that people ages 50 and up had a higher risk of chronic pain than younger adults. However, not all cases persist: Around 10% of adults who reported chronic pain in 2019 said they were pain-free in 2020.
To treat chronic pain, many doctors start by prescribing mild painkillers like ibuprofen or acetaminophen, then move to stronger drugs like opioids, according to Gregory Scherrer, whose lab at the University of North Carolina School of Medicine studies the underlying mechanisms behind pain.
But Scherrer, who wasn’t part of the NIH research, said that “it’s not clear that opioids are always useful,” especially given that they are addictive and come with side effects such as drowsiness and sedation.
Mackey estimated that in total, a couple hundred medications are available for people with chronic pain. But almost all are prescribed off-label, he said, which means they may not have been studied as treatments for chronic pain in large trials and aren’t always covered by insurance.
Doctors sometimes repurpose antidepressants, anti-seizure medications or drugs for abnormal heart rhythms for chronic pain patients, he said.
“One of the biggest problems we have in society is accessibility and affordability of access to these treatments,” Mackey added.
In a study last year, around 20% of people with chronic severe back pain said they weren’t receiving treatment for it (though the study did not account for the use of over-the-counter medications).
Other options for managing chronic pain include physical therapy, psychotherapy and nerve blocks — injecting an anesthetic or anti-inflammatory drug at the site of the pain.
There is no one-size-fits-all approach, Mackey said, and research is underway to give patients better options.
Scherrer’s lab, for instance, is researching ways to develop new nonaddictive painkillers. In particular, he’s hoping to identify nerve cells that are responsible for the physical sensation of pain.
“The goal would be to be able to shut off those cells or decrease their activity,” he said.
Scherrer and Mackey both said methods that stimulate nerve cells with electrodes or magnets have also shown promise.
One such technique, called peripheral nerve stimulation, involves a procedure that implants electrodes along nerves outside the brain and spinal cord. The electrodes send pulses to the nerves that trick the brain into turning off or weakening pain signals.
Another approach, transcranial magnetic stimulation, involves holding an electromagnetic coil against the scalp, which sends pulses to the brain that similarly mask pain signals.
Richard Nahin, an epidemiologist at the National Center for Complementary and Integrative Health who led the NIH study, said physicians have also gotten more interested in integrative therapies for chronic pain like acupuncture, massage therapy and yoga.
“Certainly in our clinical trials, which are published in major journals, we are finding benefits to these nonpharmacological approaches,” he said.
Scherrer emphasized the benefits of cognitive behavioral therapy as well, which focuses on changing thoughts, beliefs and attitudes to assist with pain management.
“Sometimes the brain can fix itself,” Scherrer said. “If you promote a positive attitude and try to encourage the patient to believe that the treatment is going to work, it’s more likely to be successful.”
A trial of 850 participants found that cognitive behavioral therapy led to a modest pain reduction but did not reduce the use of opioid medication.
The ideal pain management strategy likely involves a combination of different treatments and interventions, experts said.
In general, Mackey added, it’s better to get treated early, before a person’s pain starts to diminish their quality of life.
“If it is intruding on your ability to work, to play, to engage with family and friends, then by all means don’t suffer in silence. Seek out a good clinician,” he said.
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