Pain drives rising disability rates among middle-aged and older adults, UB study finds

BUFFALO, N.Y. – Pain is not merely a symptom of an underlying condition or disease. Researchers now see chronic pain as a condition of its own, based on common mechanisms and shared biological, psychological and social consequences across different types of pain.

Chronic pain, which is longstanding pain that persists for over three months, was included in the most recent revision of the International Classification of Diseases, a clinical resource maintained by the World Health Organization and used in 35 countries worldwide.

Although pain is a leading cause of disability, little research has examined whether the rising prevalence of pain in the U.S. has shaped disability trends.

“This is a particularly important question given that in recent decades disability rates in the U.S. have ceased to decline, or depending on the type of disability examined, have even risen,” says Hangqing Ruan, PhD, a postdoctoral fellow in the University at Buffalo College of Arts and Sciences, and the corresponding author of a new study that suggests pain is a major factor contributing to these trends.

The study, published in the Journals of Gerontology, Psychological Sciences and Social Sciences, used 17 years of data (2002-18) from the National Health Interview Survey (NHIS) to analyze pain’s impact on disability trends over time.

Ruan notes that this is the first systematic, national examination of pain as a contributor to disability.

“And the evidence,” he says, “is compelling.”

The research team used “functional limitations” as their measure of disability, which would include physical activities such as lifting a 10-pound object or climbing 10 stairs.

The prevalence of functional limitations among U.S. adults rose from 43% to 50%, with 40% of that increase attributed to rising pain prevalence.

The number of people who identified painful conditions as the cause of their functional limitations increased by 23% during the NHIS survey period. That represents an additional 9.82 million Americans whose disability is attributable to pain.

The specific pain conditions most likely to contribute to disability were arthritis/rheumatism, back and neck problems, and other musculoskeletal and connective conditions.

“Our study highlights the importance of addressing pain to curb rising disability rates,” says Ruan. “This work paves the way for policies and interventions that prioritize pain management to help mitigate broader societal challenges associated with aging and disability.”

“Research on disability trends has largely ignored the role of pain,” says Hanna Grol-Prokopczyk, PhD, an associate professor in the Department of Sociology and Criminology at UB who is one of the paper’s co-authors.

“This study highlights that pain plays a major role in recent unfavorable disability trends in the U.S., and more broadly that pain must be considered when assessing overall population health,” Adds Grol-Prokopczyk.

Additional co-authors include Zachary Zimmer, PhD, a professor in the Department of Family Studies and Gerontology at Mount Saint Vincent University, and Anna Zajacova, PhD, a professor in the Department of Sociology at the University of Western Ontario.