Prevalence and Impact of Chronic Pain in the United States
1. Prevalence of Chronic Pain
Chronic pain remains a major public health issue in the United States. Based on the 2023 National Health Interview Survey (NHIS):
- Approximately 24.3 % of U.S. adults reported experiencing chronic pain on most days or every day in the past three months.
- 8.5 % of adults reported high-impact chronic pain — pain that frequently limits life or work activities.
- Both chronic pain and high-impact chronic pain increased steadily with age and were more common among women and American Indian/Alaska Native adults compared with other racial and ethnic groups.
- Prevalence also tended to be higher in less urbanized regions.
(Chronic Pain and High-impact Chronic Pain in U.S. Adults, 2023. NCHS Data Brief, No. 518, November 2024) - Recent research indicates that between 2019 and 2023, chronic pain prevalence increased from ~20 % to ~24.3 %, and high-impact pain increased from ~7.5 % to ~8.5 %. This increase occurred across most demographic groups and pain sites, suggesting a growing population health burden.
(Pain among US adults before, during, and after the COVID-19 pandemic: a study using the 2019 to 2023 National Health Interview Survey. Anna Zajacova , Hanna Grol-Prokopczyk, Richard L Nahin. Pain. 2026 Jan 1;167(1):142-149. doi: 10.1097/j.pain.0000000000003764. Epub 2025 Aug 5.)
2. Economic Costs
Economic analyses show that chronic pain imposes significant costs on U.S. society:
- A 2021 U.S. economic burden analysis estimated total annual costs of chronic pain at approximately $722.8 billion, of which about $530.6 billion were additional medical expenditures and $192.2 billion were lost work productivity.
- These estimates are based on nationally representative expenditure and health survey data and reflect productivity losses, disability, and direct health care use among those with chronic pain compared with those without.
(Economic Costs of Chronic Pain-United States, 2021. Gery P Guy Jr , Gabrielle F Miller , Jaswinder K Legha , S Michaela Rikard , Andrea E Strahan , Christina Mikosz , Curtis S Florence. Med Care. 2025 Sep 1;63(9):679-685. doi: 10.1097/MLR.0000000000002181. Epub 2025 Jul 3.)
3. Individual and Functional Impact
Chronic pain has profound effects on daily life, psychological well-being, and work capacity:
- Chronic pain leads to limitations in work, household activities, social participation, and overall quality of life.
- High-impact chronic pain — pain that regularly interferes with life or work — disproportionately affects older adults and those with other chronic conditions.
(Chronic Pain and High-impact Chronic Pain in U.S. Adults, 2023. NCHS Data Brief No. 518, November 2024.)
4. Mental Health Comorbidity and Barriers to Care
Mental health comorbidity
- People living with chronic pain are substantially more likely to experience symptoms of anxiety and depression than those without chronic pain.
- Surveys show that adults with co-occurring chronic pain and mental health needs are both more likely to require mental health care and less likely to receive effective treatment compared with those without chronic pain. For example, among U.S. adults with such needs, only ~44 % with chronic pain reported receiving mental health treatment that successfully reduced anxiety/depression symptoms, versus ~71 % among those without chronic pain.
- Chronic pain interacts with mental health in complex ways; pain can both contribute to and be exacerbated by emotional distress, underscoring the need for integrated assessment and treatment approaches.
(The unmet mental health needs of U.S. adults living with chronic pain. De La Rosa, Jennifer S.; Brady, Benjamin R.; Herder, Katherine E.; Wallace, Jessica S; Ibrahim, Mohab M.; Allen, Alicia M.; Meyerson, Beth E.; Suhr, Kyle A.; Vanderah; Todd W. Pain 165(12):p 2877-2887, December 2024. | DOI: 10.1097/j.pain.0000000000003340)
Access and treatment barriers
- Chronic pain is often underreported, underdiagnosed, and undertreated — especially among populations with limited access to specialty care or mental health services.
- Barriers include insurance limitations on nonpharmacologic care (e.g., physical therapy, behavioral therapy), shortage of trained pain and behavioral health providers, and stigma associated with pain and mental health care. Evidence suggests that individuals with chronic pain receive mental health services less often and benefit less from them compared with those without pain, even when services are used.
(The unmet mental health needs of U.S. adults living with chronic pain. De La Rosa, Jennifer S.; Brady, Benjamin R.; Herder, Katherine E.; Wallace, Jessica S.; Ibrahim, Mohab M.; Allen, Alicia M.; Meyerson, Beth E.; Suhr, Kyle A.; Vanderah, Todd W. Pain 165(12):p 2877-2887, December 2024. | DOI: 10.1097/j.pain.0000000000003340.)
5. Disparities in Chronic Pain Experience and Care
Sociodemographic disparities
- Chronic pain prevalence and impact are not uniform across populations.
- Older adults, women, non-Hispanic American Indian/Alaska Native adults, and rural residents consistently report higher rates of both chronic and high-impact chronic pain.
- Certain sexual orientation and social groups also show elevated prevalence.
(Chronic Pain and High-impact Chronic Pain in U.S. Adults, 2023. NCHS Data Brief No. 518, November 2024.) - Though not always captured in broad national surveys, extensive research highlights racial, gender, and geographic disparities in pain assessment, treatment, and outcomes, with minority and underserved populations often experiencing less effective pain management and higher functional impairment.
- (Emerging approaches to addressing longstanding inequities: Insights from the Journal of Pain special issue on pain disparities. Emily J. Bartley Ph.D., Mary R. Janevic Ph.D., Martha O. Kenney M.D. The Journal of Pain Volume 37, Supplement, December 2025, 105509.)
6. Contemporary Understanding of Chronic Pain
Biopsychosocial model
- Modern pain science views chronic pain as a biopsychosocial phenomenon, influenced by biological mechanisms (including nervous system sensitization), psychological factors (mood, stress, coping), and social determinants (access to care, support systems).
Multimodal and interprofessional treatment
- Evidence supports multimodal pain management that integrates pharmacologic and nonpharmacologic strategies — such as physical therapy, cognitive-behavioral therapy, mindfulness, and interdisciplinary care — tailored to the individual’s clinical and psychosocial needs.
- Barriers to implementing multimodal approaches include inadequate reimbursement for nonpharmacologic care, limited provider availability, and fragmented care delivery systems.
(Access to Multimodal Pain Management for Patients with Chronic Pain: an Audit Study. Pooja Lagisetty, Stephanie Slat, Jennifer Thomas, Colin Macleod, Goodarz Golmirzaie, Amy SB Bohnert J Gen Intern Med. 2020 May 6;36(3):818-820. Doi: 10.1007/s11606-020-05866-3.)
Integrated care needs
- Addressing chronic pain effectively requires not only symptom relief but also attention to psychological well-being, functional capacity, and social support. This comprehensive perspective aims to improve quality of life, reduce disability, and mitigate long-term societal costs.
7. Conclusion
- Chronic pain continues to affect millions of Americans and remains a growing public health challenge. Recent national data show that nearly 1 in 4 adults experiences daily or near-daily pain, and a substantial portion suffers from high-impact pain that limits life activities. Chronic pain carries a major economic burden — now estimated at over $720 billion annually — and is closely linked with mental health symptoms, functional limitation, and disparities in care. Evidence supports multimodal, biopsychosocial approaches and a focus on improved access to integrated pain and mental health services as priorities in advancing care and reducing suffering.
