Epidemiology of Pain

National Center For Complementary & Integrative Health

Investigators

Abstract

This was the first full year of the Epidemiology Program in the NCCIH Intramural Program. After national searches, two individuals were identified for Research Fellow positions within the Program. The hires are on hold pending Executive Order. All work performed by members of the Epidemiology Program has been exempted from NIH IRB review given that existing, publicly available, de-identified datasets, most created by the CDC or AHRQ, form the basis for analyses. Over the last year we have been working on several large projects using data from either the CDC’s National Health Interview Survey (NHIS) or the AHRQ Medical Expenditures Panel Survey (MEPS). Using NHIS data we have been exploring risk factors for chronic pain (CP) and high impact chronic pain (HICP) and comparing these risk factors to those of other chronic diseases including asthma, diabetes, heart disease, hypertension and obesity. Our study provides the first comprehensive analysis of incidence rates across 12 leading chronic diseases in a nationally representative longitudinal sample of U.S. adults, addressing a critical gap in public health research that has persisted for decades. We used a consistent group of factors to identify risk of disease by sex, age, race, ethnicity, education attainment, type of health insurance, and cigarette smoking status. We present both standardized cumulative incidence and incidence rates stratified by sex to establish a basis for international comparison, assessing prevention strategies, and informing public health initiative and policies. We observed significant heterogeneity in incidence rates and risk factors among the 12 studied diseases, with diseases associated with lower mortality rates (arthritis, CP, high cholesterol) having higher incidence rates than diseases with higher mortality rates (e.g., cancer, CHD, COPD, diabetes). We expect that many other high-income countries will have similar distributions of burden. In a second study using NHIS we examined rural health disadvantages for pain management. Little is known about whether the transitions between different pain states (i.e., pain development and recovery) vary across the rural–urban continuum for the US total population and whether any disparities vary across different demographic groups and regions. We found that rural–urban disparities in pain incidence and recovery rates are consistent across different subpopulations and by regions, but the magnitudes of the effect size are more pronounced for certain population groups than for others. Regarding pain incidence, these disparities are most notable among males, middle-aged adults, and non-Hispanic Whites—groups in rural areas particularly vulnerable to “deaths of despair.” Rural–urban gaps in pain recovery are particularly significant among middle-aged adults and residents in the South, indicating once pain develops, these groups in rural areas may face challenges in accessing effective approaches for managing and improving their conditions and thus need more attention. Pain is recognized as a complex experience that requires multimodal multidisciplinary/interdisciplinary approaches (MM/IAs) for optimal patient outcomes. The DHHS Pain Management Best Practices Interagency Task Force Report (HHS Report) emphasizes the use of MM/IAs as best practices for pain management. This type of approach has been shown to decrease pain, improve mood and quality of life, preserve function, and increase overall wellbeing. However, these is no national data on the use of MM/IAs for pain. To address this gap, we used data for the MEPS. Specifically, we explored whether best practices guidelines are being met during treatment of US adults with high impact pain. We found significant differences in care seeking across demographics among people reporting pain. Specifically, Hispanic and non-Hispanic (NH) Black adults were 53-56% less likely to seek medical care for pain compared to NH White adults. In addition, individuals with lower educational attainment and public health insurance, were also at significantly reduced odds of seeking ambulatory medical care. Sensitivity analysis indicated individuals with a pain condition who reported Puerto Rican, Cuban, Mexican/Mexican Ameri/Mexicano/Chicano, Dominican, Central or South American, and other Hispanic ancestry were ~50-60% less likely than NH White adults to seek any outpatient medical care. Of those individuals who did seek medical care for pain management, NH Black, NH Asian, and Hispanic population groups were approximately 56-60% more likely to seek care from only a primary care physician for pain compared to NH White adults, while NH Whites were 50% more likely to see two or more provider types (e.g., primary care doc and pain specialist) than minority groups.