Poorly educated, low-income older Americans are much more likely to suffer from chronic pain than their wealthier, more highly educated counterparts, but the disparity between the two groups is much greater than previously thought, according to a new study by a medical sociologist at the University at Buffalo (UB).
The findings, published in the journal Pain, reveal that people with the lowest levels of education are 80 percent more likely to experience chronic pain than people with the highest levels. The results are based on 12 years of data on more than 19,000 subjects aged 51 and over, excluding those diagnosed or treated for cancer.
The study also found that chronic pain levels are rising by time period and not just by age, meaning people who were in their 60s in 2010 reported more pain than people who were in their 60s in 1998.
“I found that people with lower levels of education and wealth don’t just have more pain, they also have more severe pain,” says study author Hanna Grol-Prokopczyk, an assistant professor of sociology at UB.
“I also looked at pain-related disability, meaning that pain is interfering with the ability to do normal work or household activities. And again, people with less wealth and education are more likely to experience this disability.”
The findings also serve as an argument for investing in more research for non-opioid treatments.
“There are a lot of pressures right now to reduce opioid prescription,” says Grol-Prokopczyk. “We don’t have particularly good treatments for chronic pain. If opioids are to some extent being taken off the table, it becomes even more important to find other ways of addressing this big public health problem.”
Tens of millions of American adults experience chronic pain. A 2011 Institute of Medicine report (now the National Academy of Science Health and Medicine Division) noted that chronic pain affects more people and costs the economy more money than heart disease, cancer and diabetes combined.
“In part, this study should be a reminder that many people are legitimately suffering from pain. Health care providers shouldn’t assume that someone who shows up in their office complaining of pain is just trying to get an opioid prescription. We have to remember that pain is a legitimate and widespread problem,” says Grol-Prokopczyk.
Until now, most research on the subject has asked only whether people had chronic pain or not. The new study is among the first to look beyond the simple presence or absence of chronic pain to examine instead matters of degree, asking whether the pain was mild, moderate or severe.
The researchers also followed these same subjects over 12 years, as opposed to most studies that only highlight a particular point in time.
The findings show that people with the least education are 80 percent more likely to experience chronic pain than people with the most. When it comes to severe pain, subjects who didn’t finish high school are 370 percent more likely to experience severe chronic pain than those with graduate degrees.
“If you’re looking at all pain — mild, moderate and severe combined — you do see a difference across socioeconomic groups. And other studies have shown that. But if you look at the most severe pain, which happens to be the pain most associated with disability and death, then the socioeconomically disadvantaged are much, much more likely to experience it.”
More research is needed to truly understand why pain is so unequally distributed in the population, but Grol-Prokopczyk says it’s critical to keep the high burden of pain in mind in this period of concern over the opioid epidemic.
“If we as a society decide that opioid analgesics are often too high risk as a treatment for chronic pain, then we need to invest in other effective treatments for chronic pain, and/or figure out how to prevent it in the first place,” she says.
Source: University at Buffalo