More than a quarter of Americans experience pain

May 01, 2008

More than a quarter of American men and women report feeling pain at any point in time, and those with lower incomes and less education spent more time in pain and had higher than average pain. These are the conclusions of authors of an Article published in this week's edition of The Lancet.

Pain imposes considerable costs on the health-care system and economy, and the occurrence of pain is a major reason for people seeing their doctor and taking medications. In the US, over $2.6 billion was spent on non-prescription painkillers in the year ending March 2007, and in 2004 -- the last year with data available -- $13.8 billion was spent on outpatient painkillers. Pain also decreases labour workforce availability and is estimated to cost over $60 billion a year in lost productivity.

Dr Alan Krueger, Princeton University, NJ, USA, and Dr Arthur Stone, Stony Brook University, NY, USA, did a community-based telephone survey that attempted to contact around 10,700 people via random-digit dialling. They collected diary information for one day, and ratings of pain between 0 and 6 (0=no pain 6=extremely strong pain) for three randomly selected 15-minute intervals of the day were obtained. The outcomes measured were proportion of time intervals with no pain, proportion of time intervals with moderate-to-severe pain, and average pain rating. Activities of people who reported substantial pain were also examined. To make the data representative of the US population, the data were adjusted with sample weights from the Gallup Organisation. The study was founded by the National Institute of Aging (US) and the Hewlett Foundation.

The researchers interviewed 3982 people (response rate=37%) and after re-weighting the sample for non-response, 29% of men and 27% of women reported feeling some pain at sampled times. People with lower incomes or less education spent a higher proportion of time in pain and reported feeling more severe pain than those with higher income or more education. The average pain rating increased with age, although it reached a surprising temporary plateau between the ages of 45-75 years, before rising again above 75 years, with little difference between men and women. Generally, the more satisfied people were with their life/health, the lower their pain rating. In terms of activity categories, people engaged in personal care, lawn and garden work, sports and exercise (men only) and providing medical care (women only) reported higher than average pain ratings than other activities.

The authors say that while their study did not support previous findings that women experience more pain than men, it did reinforce conclusions from other studies that people with lower incomes generally experienced more pain. The study provides some evidence that the income-pain gradient is linked to occupational status - namely that blue-collar workers have higher pain during work episodes than non-work episodes. White -collar workers have lower pain than blue-collar workers, and the same amount during work and non-work periods. The authors conclude: "The diary-survey methods described here could be used to study pain at the population level, and will enable the combination of pain assessments with information about activities of daily living."

In an accompanying Comment, Dr Juha Turunen, University of Kuopio, Finland, says: "I hope that more studies like this will help to find ways of identifying subgroups needing help with their pain, for example to enable pain sufferers to obtain quicker and easier access to multidisciplinary pain clinics."
Dr Alan Krueger, Princeton University, NJ, USA T) +1 609-635-5556 / +1 609-258-4046 E)

Dr Arthur Stone, Stony Brook University, NY, USA

Dr Juha Turunen, University of Kuopio, Finland T) +358 (0) 40 581 5813 E)


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