Highlights
- •The National Pain Strategy calls for population research on high-impact chronic pain.
- •We examined sociodemographic disparities in such pain in the United States.
- •Approximately 8% of adults older than age 50 have high-impact chronic pain.
- •High-impact pain prevalence rose sharply with decreasing household wealth.
- •Black compared to white adults had greater pain-related disability across domains.
Abstract
The U.S. National Pain Strategy calls for increased population research on “high-impact
chronic pain” (ie, longstanding pain that substantially limits participation in daily
activities). Using data from the nationally-representative Health and Retirement Study
(HRS), we investigated the prevalence of high-impact chronic pain in U.S. adults older
than age 50 overall and within population subgroups. We also explored sociodemographic
variation in pain-related disability within specific activity domains. Data are from
a subsample of HRS respondents (n = 1,925) who were randomly selected for a supplementary
pain module in 2010. Our outcome was operationalized as pain duration of ≥7 months
and a disability rating of ≥7 (0–10 scale) in at least 1 domain: family/home, leisure,
social activities, work, or basic activities. Overall, 8.2% (95% confidence interval = 6.7–10.1%)
of adults older than age 50 met criteria for high-impact chronic pain. This proportion
rose to 17.1% (95% confidence interval = 12.3–23.4%) among individuals in the lowest
wealth quartile. Prevalence differences according to education, race/ethnicity, and
age were not significant. Arthritis and depression were significantly associated with
high-impact pain in multivariable analysis. Among adults with any chronic pain, African
American and individuals in the lowest wealth quartile reported more pain-related
disability across activity domains.
Perspective
High-impact chronic pain is unequally distributed among midlife and older U.S. adults.
Efforts to reduce the burden of disabling chronic pain should prioritize socioeconomically
vulnerable groups, who may have the least access to multimodal pain treatment to improve
function.
Key words
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References
- Health disparities across the lifespan: Meaning, methods, and mechanisms.Ann N Y Acad Sci. 2010; 1186: 5-23
- Goodness-of-fit tests for logistic regression models when data are collected using a complex sampling design.Comput Stat Data Anal. 2007; 51: 4450-4464
- Socioeconomic status in health research: One size does not fit all.JAMA. 2005; 294: 2879-2888
- Using multiple-hierarchy stratification and life course approaches to understand health inequalities: The intersecting consequences of race, gender, SES, and age.J Health Soc Behav. 2016; 57: 200-222
- Challenges and opportunities in pain management disparities research: Implications for clinical practice, advocacy, and policy.J Pain. 2012; 13: 611-619
- Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial.JAMA. 2016; 315: 1240-1249
- Cognitive performance in women aged 50 years and older with and without fibromyalgia.J Gerontol Ser B Psychol Sci Soc Sci. 2014; 69: 199-208
- RAND Health and Retirement Study (HRS) Data Documentation.RAND Center for the Study of Aging, 2016 (Available at: http://hrsonline.isr.umich.edu/modules/meta/rand/. Accessed June 25, 2017)
- Pain, functional limitations, and aging.J Am Geriatr Soc. 2009; 57: 1556-1561
- Age differences in the correlates of physical functioning in patients with chronic pain.J Aging Health. 2006; 18: 56-69
- Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research.Am Psychol. 2014; 69: 153-166
- Overview of aging and pain, in: Pain in the Elderly.IASP Press, Seattle, WA1996: 1-10
- Do US black women experience stress-related accelerated biological aging?: A novel theory and first population-based test of black-white differences in telomere length.Hum Nat. 2010; 21: 19-38
- The unequal burden of pain: Confronting racial and ethnic disparities in pain.Pain Med. 2003; 4: 277-294
- Sociodemographic disparities in chronic pain, based on 12-year longitudinal data.Pain. 2017; 158: 313-322
- The pain experience of Hispanic Americans: A critical literature review and conceptual model.J Pain. 2016; 17: 513-528
- A public health approach to addressing arthritis in older adults: The most common cause of disability.Am J Public Health. 2012; 102: 426-433
- Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.National Academies Press, Washington, DC2011
- The prevalence of chronic pain in United States adults: Results of an Internet-based survey.J Pain. 2010; 11: 1230-1239
- Allostatic load biomarkers of chronic stress and impact on health and cognition.Neurosci Biobehav Rev. 2010; 35: 2-16
- Dynamics of work disability and pain.J Health Econ. 2008; 27: 496-509
- Translational behavioral pain management: New directions and new opportunities.Transl Behav Med. 2012; 2: 19-21
- Stress, life events, and socioeconomic disparities in health: Results from the Americans’ Changing Lives Study.J Health Soc Behav. 2005; 46: 274-288
- Migraine prevalence, disease burden, and the need for preventive therapy.Neurology. 2007; 68: 343-349
- Controlling for socioeconomic status in pain disparities research: All-else-equal analysis when “all else” is not equal.Pain Med. 2015; 16: 2222-2225
- Advancing a national agenda to eliminate disparities in pain care: Directions for health policy, education, practice, and research.Pain Med. 2012; 13: 5-28
- Estimates of pain prevalence and severity in adults: United States, 2012.J Pain. 2015; 16: 769-780
- Out-of-pocket expenditures on complementary health approaches associated with painful health conditions in a nationally representative adult sample.J Pain. 2015; 16: 1147-1162
National Pain Strategy: A Comprehensive Population Health Strategy for Pain. US Department of Health and Human Services, 2016. Available at: https://iprcc.nih.gov/docs/HHSNational_Pain_Strategy.pdf. Accessed June 25, 2017.
- The CDC guideline on opioid prescribing: Rising to the challenge.JAMA. 2016; 315: 1577-1579
- Pain management to promote independence in older adults.J Am Geriatr Soc. 2010; 58: 1195-1196
- Socioeconomic disadvantage and pain.Pain. 2008; 136: 235-238
- Should health studies measure wealth? A systematic review.Am J Prev Med. 2007; 33: 250-264
- Do wealth disparities contribute to health disparities within racial/ethnic groups?.J Epidemiol Community Health. 2013; 67: 439-445
- Population-based survey of pain in the United States: Differences among white, African American, and Hispanic subjects.J Pain. 2004; 5: 317-328
- Practical Guide to Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.National Institutes of Health, Bethesda, MD2000
- Pain in aging community-dwelling adults in the United States: Non-Hispanic whites, non-Hispanic blacks, and Hispanics.J Pain. 2007; 8: 75-84
- Associations of socioeconomic position and pain prevalence in the United States: Findings from the National Health and Nutrition Examination Survey.Pain Med. 2014; 15: 1508-1521
- Age and the experience of chronic pain: Differences in health and quality of life among younger, middle-aged, and older adults.Clin J Pain. 2005; 21: 513-523
- The Health and Retirement Study: A public data resource for research on aging.Open Health Data. 2014; 2: e7
- Documentation of affective functioning measures in the Health and Retirement Study.Survey Research Center, University of Michigan, Ann Arbor, MI2000
- Pain is associated with recurrent falls in community-dwelling older adults: Evidence from a systematic review and meta-analysis.Pain Med. 2014; 15: 1115-1128
- Racial/ethnic disparities in the assessment and treatment of pain: Psychosocial perspectives.Am Psychol. 2014; 69: 131-141
- The Pain Disability Index: Psychometric and validity data.Arch Phys Med Rehabil. 1987; 68: 438-441
- United States National Pain Strategy for population research: Concepts, definitions, and pilot data.J Pain. 2016; 17: 1068-1080
- Racial residential segregation: A fundamental cause of racial disparities in health.Public Health Rep. 2001; 116: 404-416
Article info
Publication history
Published online: July 28, 2017
Accepted:
July 17,
2017
Received in revised form:
June 27,
2017
Received:
March 23,
2017
Footnotes
This work was supported in part by the National Institute on Aging (K01 AG050706 to M.R.J.). The Health and Retirement Study is sponsored by the National Institute on Aging (U01AG009740) and is conducted by the University of Michigan. Support was also provided by the National Institutes of Health (P30DK092926). J.D.P. is a VA Research Career Scientist.
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2017 Published by Elsevier Inc. on behalf of the American Pain Society
