Between combined years 1997/1998 and 2013/2014, the number of U.S. adults experiencing non-cancer pain increased by 25 percent, and yet during this same period there was a decrease in visits to health care providers for pain, a small decrease in prescription pain medications overall, but a large increase in the use of opioids, especially strong opioids. Individuals from the National Center for Complementary and Integrative Health, Social & Scientific Systems, and Yale University School of Medicine, Yale Center for Medical Informatics analyzed data from a national survey. The analysis was published in The Journal of Pain.
Researchers calculated annual pain prevalence among cancer-free U.S. adults aged 18 and older by using the 1997-2014 Medical Expenditure Panel Survey, which is a nationally representative survey of the U.S. civilian, noninstitutionalized population and is maintained by the Agency for Healthcare Research and Quality (AHRQ). The survey asked participants to rate how much their pain interfered with normal work (including both work outside the home and housework) over the previous 4 weeks. Participants were also asked if they had seen a health care provider for their pain and if they took any prescription pain medications, including opioids, for their pain.
Prevalence rates resulting from the study’s analyses were age-adjusted to account for secular changes over time in the study population (e.g., aging U.S. population):
- In combined years 1997/1998, 32.9 percent of U.S. adults reported having one or more diagnosed painful health condition (unrelated to cancer) within the last year, which is equivalent to 120.2 million people. By 2013/2014, the percentage increased to 41 percent, which is equivalent to 178 million people.
- In combined years 2013/2014, a little more than one-third (68 million) of U.S. adults with a painful health condition reported moderate or severe pain-related interference with normal work activities (job or home).
- Between combined years 2001/2002 and 2013/2014, there was a 15.7 percent increase in those reporting painful health condition(s) and severe pain-related interference. By 2013/2014, 8.1 percent of U.S. adults (32.3 million) had severe pain-related interference.
- The use of opioids specifically for pain management increased from 11.8 percent of those with a painful health condition (14.5 million adults) in combined years 1997/1998 to 16.2 percent (30.6 million adults) in 2013/2014. Across years, increased levels of pain-related interference were associated with higher opioid use.
- The use of weak opioids (such as codeine) for pain decreased during this period, while the use of strong opioids (such as morphine or oxycodone) increased substantially. These changes in prevalence translate into large increases in the number of adults using strong opioid medications for pain management—from 6.8 million adults in combined years1997/1998 to 22.7 million adults in 2013/2014.
- Across years, compared to people with minimal pain-related interference, those with severe pain-related interference were more likely to use strong opioids, to report four or more opioid prescriptions, and to have six or more ambulatory office visits for their pain.
The researchers noted there may be several explanations for the decrease in health care provider visits for pain, including that older adults, those most likely to have a painful health condition, may be reluctant to use types of invasive health care based on their own perceptions about the inevitability of pain in older age. As the use of strong opioids remains high, especially in those with severe pain-related interference, the researchers also noted that additional education of health care providers and the public concerning the risk/benefit ratio of opioids appears warranted.
- Nahin RL, Sayer B, Stussman BJ, et al. 18-year trends in the prevalence of, and health care use for, non-cancer pain in the United States: data from the Medical Expenditure Panel Survey. The Journal of Pain. February 13, 2019. Epub ahead of print.