New cases of chronic pain outnumber those of diabetes or depression, study shows

New cases of chronic pain are more common in the United States than those of other chronic conditions, such as diabetes, depression and high blood pressure, according to a study from the National Institutes of Health. The findings provide large-scale confirmation of what previous research has shown: chronic pain is staggeringly common in America.

Experts know that about one-fifth of American adults have chronic pain, but the new study provides a snapshot of how many people suffer each year. Researchers analyzed data from 10,415 adults who participated in two editions of an annual survey led by the Centers for Disease Control and Prevention; respondents reported how often they felt pain in the past three months and whether that pain interfered with their daily lives.

“We’re talking about a major public health problem,” said Dr. Gregory Terman, a pain medicine specialist at the University of Washington School of Medicine and co-author of the study.

The study shows that as more people develop new cases of chronic pain, existing patients struggle to recover. Only about 10 percent of those with chronic pain in 2019 were pain-free in 2020, underlining how difficult it is to treat.

“It’s astronomical,” said Richard L. Nahin, the study’s lead author and the chief epidemiologist at the National Center for Complementary and Integrative Health.

And it’s possible that these numbers have grown during the coronavirus pandemic, said Beth Darnall, a professor of anesthesiology, perioperative medicine and pain medicine at Stanford School of Medicine, who was not involved in the study. But a number of existing and emerging treatments can relieve pain.

“There really are solutions and there is help,” said Dr. Darnall. “Unfortunately, it’s just not easy to find.”

Why is chronic pain so difficult to treat?

It is difficult to establish a single definition of pain. The study defined people with chronic pain as those who said they were in pain most days or every day for the past three months. And chronic pain itself can be a disease, said Dr. Prasad Shirvalkar, an associate professor of anesthesia and neurological surgery at the University of California, San Francisco, who studies pain management. He added that it can take years for some patients to receive an accurate diagnosis for conditions that cause chronic pain, with more than a third of cases occurring with no apparent cause.

“It’s like a fire alarm goes off, but there’s no fire,” he said.

Even when doctors can diagnose conditions that cause chronic pain, many are not equipped to treat it. “There really is an undervaluation in the medical community about pain management,” says Dr. Michael Bottros, chief of clinical operations and medical director of pain services at the Keck School of Medicine at the University of Southern California. And because pain is “vague” and varies from person to person, he added, it can be difficult to pinpoint the right treatments.

The study also examined how pain evolves into chronic pain. Participants who experienced acute pain were more likely to develop chronic pain in the following year, with about one in six people with non-chronic pain reporting chronic pain a year later. In other words, without early intervention, experts say, pain can sometimes get worse; what begins as an acute or occasional pain can progress into a long-term problem. But not everyone has equal access to that care, said Dr. Darnall.

How to get help for chronic pain

Experts recommend seeing a doctor first if you experience pain that interferes with your daily life. If you don’t improve after six weeks, Dr. Bottros to find a specialist. If you’re struggling to find a chronic pain specialist, Dr. Shirvalkar to visit major university pain centers, many of which offer telehealth appointments.

Community hospitals may also be able to offer resources. Dr. Darnall said advocacy groups for certain conditions, such as the Marfan Foundation, can also provide educational materials and help patients find providers. Recent changes in Medicare have also expanded coverage for chronic pain treatment, said Dr. Nahin.

In response to the opioid epidemic, some physicians have attempted to move away from medication as the first response to treating chronic pain. It’s critical to treat chronic pain through a multimodal approach, experts said, using a variety of therapies. For example, a patient can go to physiotherapy, but also to a mental health professional for cognitive behavioral therapy. “One kind of treatment will never be enough,” said Dr. Shirvalkar.

Mental health care is a very promising but often underutilized way to address chronic pain. “A psychologist can fundamentally help reframe how people relate to their pain or even the signals they listen to in their bodies,” said Dr. Shirvalkar.

Newer treatments are also on the way: Researchers are exploring whether psychedelics, virtual reality treatments, and brain stimulation can relieve pain.

“It’s not a one-size-fits-all,” said Dr. Darnall. “Patients are not a monolith.”