Chronic Pain Among Adults — United States, 2019–2021
Open accessAbstract
Chronic pain (i.e., pain lasting ≥3 months) is a debilitating condition that affects daily work and life activities for many adults in the United States and has been linked with depression (1), Alzheimer disease and related dementias (2), higher suicide risk (3), and substance use and misuse (4).During 2016, an estimated 50 million adults in the United States experienced chronic pain, resulting in substantial health care costs and lost productivity (5,6).Addressing chronic pain and improving the lives of persons living with pain is a public health imperative.Population research objectives in the National Pain Strategy, which was released in 2016 by the Interagency Pain Research Coordinating Committee, call for more precise estimates of the prevalence of chronic pain and high-impact chronic pain (i.e., chronic pain that results in substantial restriction to daily activities) in the general population and within various population groups to guide efforts to reduce the impact of chronic pain (3).Further, a 2022 review of U.S. chronic pain surveillance systems identified the National Health Interview Survey (NHIS) as the best source for pain surveillance data (7).CDC analyzed data from the 2019-2021 NHIS to provide updated estimates of the prevalence of chronic pain and highimpact chronic pain among adults in the United States and within population groups defined by demographic, geographic, socioeconomic, and health status characteristics.During 2021, an estimated 20.9% of U.S. adults (51.6 million persons) experienced chronic pain, and 6.9% (17.1 million persons) experienced high-impact chronic pain.New findings from this analysis include that non-Hispanic American Indian or Alaska Native (AI/AN) adults, adults identifying as bisexual, and adults who are divorced or separated are among the populations experiencing a higher prevalence of chronic pain and highimpact chronic pain.Clinicians, practices, health systems, and payers should vigilantly attend to health inequities and ensure access to appropriate, affordable, diversified, coordinated, and effective pain management care for all persons (8).NHIS is a cross-sectional, household survey of the civilian, noninstitutionalized population conducted annually by the National Center for Health Statistics (NCHS).*Data were analyzed using the 2019-2021 Sample Adult Interviews.† Survey questions used to estimate the prevalence of pain included, "In the past three months, how often did you have pain?Would you say never, some days, most days, or every day?" and "Over the past three months, how often did your pain limit your life or work activities?Would you say never, some days, most days, INSIDE 386 Secondary Cases of Invasive Disease Caused by Encapsulated and Nontypeable Haemophilus influenzae -10 U.S. Jurisdictions, 2011-2018 391 Update on Wild Poliovirus Type 1 Outbreak -Southeastern Africa, 2021-2022 398 Racial and Ethnic Disparities in Mpox Cases and Vaccination Among Adult Males -United States, May-December 2022 404 Epidemiologic and Clinical Features of Mpox-Associated Deaths -United States, May 10, 2022-March 7, 2023 411 Notes From the Field: Campylobacteriosis Outbreak Associated with Consumption of Raw Water -Montana, 2022 414 QuickStats
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In the US, 30.1% of those with HICP are employed.
“In the US, 30.1% of those with HICP are employed 2”
From Overview and Feasibility of a Novel Transdisciplinary Integrative Approach to High Impact Chronic Pain in Vermont (2024) · cites this paper as [2]
The 2021 prevalence table lists 5,088,000 employed adults with high-impact chronic pain, alongside 11,461,000 who had worked previously and 334,000 who had never worked. The employed group is 30.1% of those three employment-status groups combined, but the table’s overall high-impact chronic pain estimate is 17,100,000; using that denominator gives about 29.8%. The claim omits the restriction to people represented in the employment-status groups. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe mean age of the PATH participants (49.8 years) is typical of the HICP population in the US (low 50s).
“The mean age of the PATH participants (49.8 years) is also typical of the HICP population in the US (low 50s). 2”
From Overview and Feasibility of a Novel Transdisciplinary Integrative Approach to High Impact Chronic Pain in Vermont (2024) · cites this paper as [2]
The 2021 prevalence table (page not specified) reports the largest estimated number of U.S. adults with high-impact chronic pain in the 45–64 age group. It does not report a mean age or establish that the population’s mean is in the low 50s, so it cannot substantiate the comparison with PATH participants. (LLM, conf=0.77)
Experimental — accuracy not yet measuredChronic pain is one of the most common chronic conditions in the United States, with the most recent national estimate at 20.9% of US adults.
“Chronic pain is one of the most common chronic conditions in the United States based on multiple prevalence studies 1 with the most recent national estimate at 20.9% of US adults. 2”
From Overview and Feasibility of a Novel Transdisciplinary Integrative Approach to High Impact Chronic Pain in Vermont (2024) · cites this paper as [2]
The employment status of PATH participants is not typical of the US HICP population.
“The employment status, however, is not typical. In the US, 30.1% of those with HICP are employed 2 while 50% of the PATH participants are employed full-time, and 17% are employed part-time.”
From Overview and Feasibility of a Novel Transdisciplinary Integrative Approach to High Impact Chronic Pain in Vermont (2024) · cites this paper as [2]
67% of the participants were employed at least part-time versus only 30.1% of those with HICP in the US are employed.
“67% of the participants were employed at least part-time vs only 30.1% of those with HICP in the US are employed. 2”
From Overview and Feasibility of a Novel Transdisciplinary Integrative Approach to High Impact Chronic Pain in Vermont (2024) · cites this paper as [2]
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“It also significantly impacts daily activities and work performance and is associated with an increased risk of dementia and suicide, resulting in a huge medical burden and loss of productivity [4].”
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“Pain lasting three months or longer affects the activities of daily living, ability to work, and quality of life for millions of United States (US) residents [2].”
BackgroundGeorge, S. Z., Allen, K. D., Álvarez, C., Arbeeva, L. S., Callahan, L. F., Nelson, A. E., Schwartz, T. A., & Golightly, Y. M. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.104687 · Cited by 11 · see citing works
DiBlasi, E., Kaufman, E. A., Webster, S., Hagn, E. E., Shabalin, A. A., Chen, D., Han, S., Jawish, R., Monson, E. T., Staley, M., et al. (2024) · BMC Medicine · doi:10.1186/s12916-024-03794-1 · Cited by 12 · see citing works
“In the United States, estimates gathered in 2021 indicate that 20.9% of adults, or 51.6 million individuals, experienced CP, and 6.9%, or 17.1 million persons, had experienced what is termed high-impact chronic pain or CP that substantially restricts daily activities [12].”
InfluentialZajacova, A., Grol-Prokopczyk, H., & Nahin, R. L. (2025) · Pain · doi:10.1097/j.pain.0000000000003764 · Cited by 17 · see citing works
“To date, only 2 brief government reports have provided pain prevalence estimates among US adults during this period—one during the pandemic 34 and one postpandemic.”
Yi, J., Yang, L., Widman, A. J., Toliver, A., Bertels, Z., Rosario, J. S. D., Dourson, A. J., Gupta, P., Kumar, R., Li, J.-N., et al. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.03.25.645367 · Cited by 11 · see citing works
Pain Chronicity and Relief: From Molecular Basis to Exercise-Based Rehabilitation
Ni, W., Kuang, X., & Zhu, Z. (2025) · Biology · doi:10.3390/biology14091116 · Cited by 11 · see citing works
“Studies estimate that approximately 20.9% of U.S. adults experience chronic pain, with high-impact chronic pain affecting nearly 7% of individuals, severely restricting daily activities [2].”
InfluentialFrontline Perspectives on Buprenorphine for the Management of Chronic Pain
Adler, J. A., Mallick‐Searle, T., Garofoli, M., & Zimmerman, A. (2024) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s449748 · Cited by 10 · see citing works
“Treatment at the optimal dose continued for ≤48 weeks with a constant mean pain intensity score of 3–4, demonstrating the long-term efficacy of BBF. 20 All 3 studies found that BBF was well tolerated, with nausea being the adverse event reported most frequently and an adverse event discontinuation…”
BackgroundUnveiling the link between chronic pain and misuse of opioids and cannabis
Dagher, M., Alayoubi, M., Sigal, G. H., & Cahill, C. M. (2024) · Journal of Neural Transmission · doi:10.1007/s00702-024-02765-3 · Cited by 11 · see citing works
“%) experience chronic pain; 17.1 million of these individuals experience ‘high-impact’ chronic pain (pain that results in substantial restrictions to daily activities) (Rikard et al. 2023).”
InfluentialVentura, L., Santo, R. F. D. E., Keaser, M. L., Zhang, Y., Ro, J. Y., & Silva, J. T. D. (2024) · Biomedicines · doi:10.3390/biomedicines12092005 · Cited by 10 · see citing works
“Based on National Health Interview Survey data spanning 2019–2021, the Center for Disease Control and Prevention estimated a chronic pain prevalence of 20.9% among US adults (51.7 million), with females and older adults overrepresented in this number [1].”
MethodInfluentialGonadal Hormone Changes with Aging and Their Impact on Chronic Pain
Athnaiel, O., Davidson, N., Mangat, J. S., Nasr, N. F., & Knežević, N. N. (2025) · Cells · doi:10.3390/cells14020123 · Cited by 15 · see citing works
“According to the Centers for Disease Control (CDC), more than 30.8% of adults aged 65 or older live with chronic pain, which is a higher proportion than all other age groups [2].”
InfluentialGrant, A. R., Westhorp, G., Murray, C. M., de la Perrelle, L., Dettwiller, P. Y., Davey, A., Norrish, A., Walsh, S., Scinta, G., Karran, E. L., et al. (2025) · Pain · doi:10.1097/j.pain.0000000000003482 · Cited by 10 · see citing works
Smith, D. M., Beyene, R., Kolm, P., Young, T. A., Zifa, S., Natividad, V., Licata, A. L., Podolsky, R. H., Moore, T., Walsh, R., et al. (2025) · Clinical and Translational Science · doi:10.1111/cts.70154 · Cited by 10 · see citing works
Demographic variation in pain across 22 countries
Macchia, L., Okafor, C. N., Breedlove, T., Shiba, K., Piper, A., Johnson, B. R., & VanderWeele, T. J. (2025) · Communications Medicine · doi:10.1038/s43856-025-00858-y · Cited by 10 · see citing works
Cervical Spinal Cord Stimulation: A Review
Krog, L., Maloney, J. A., Pew, S., Adeleye, O., Johnson, B. W., Glenn, B., Gill, B., Francio, V. T., Pagan-Rosado, R. D., Whitney, M. A., et al. (2023) · Current Pain and Headache Reports · doi:10.1007/s11916-023-01200-8 · Cited by 10 · see citing works
Patient Motivation to Reduce or Discontinue Opioids for Chronic Pain
Crouch, T. B., Donovan, E. K., Smith, W. R., Barth, K. S., Becker, W. C., & Svikis, D. S. (2023) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001167 · Cited by 9 · see citing works
Lysetskyi, B., Kobyletskyi, O., Shchybovyk, D., Zubova, M., & Litvin, O. (2024) · Futurity Medicine. · doi:10.57125/fem.2024.03.30.05 · Cited by 9 · see citing works
Berwal, D., Brǎnişteanu, D. D. D., Glickman, M., Sagar, A., & Pilitsis, J. G. (2024) · Cytokine · doi:10.1016/j.cyto.2024.156614 · Cited by 9 · see citing works
A Review of Remote Monitoring in Neuromodulation for Chronic Pain Management
Zhong, T., William, H. M., Jin, M. Y., & Abd-Elsayed, A. A. (2024) · Current Pain and Headache Reports · doi:10.1007/s11916-024-01302-x · Cited by 9 · see citing works
“The most common locations for chronic pain are the back, hip, knee, and foot [4].”
Joo, J., Devkota, J., Stone, B. M., Dunn, K. E., Zipunnikov, V. M., Vandrey, R. G., Finan, P. H., & Thrul, J. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100784 · Cited by 9 · see citing works
Hellmann, S. S., Ekholm, O., Handberg, G., Petersen, P. L., Kurita, G. P., Sjøgren, P., Thygesen, L. C., & Vægter, H. B. (2025) · PAIN Reports · doi:10.1097/pr9.0000000000001277 · Cited by 9 · see citing works
“Heterogeneity in measuring population-based graded chronic pain distribution in current evidence 1,4,6,11–14, 17, 18,21–23, 30, 31 , 33 hinders to some degree direct comparisons.”
Rogers, A. H., Smit, T., Bakhshaie, J., & Zvolensky, M. J. (2025) · Journal of Behavioral Medicine · doi:10.1007/s10865-025-00590-x · Cited by 9 · see citing works
“Chronic pain, defined as pain persisting for at least 3 months, is a major public health problem impacting over 20% of adults (Rikard et al., 2023 ), and leads to significant economic burden (i.e. medical expenditures, missed work days) and functional impairment (Cohen et al., 2021; Lohan et al.,…”
Current Nonopioid Small Molecule Approaches Toward the Treatment of Neuropathic Pain
Cioffi, C. L., Lotsaris, I., Chater, R. C., Pati, T. K., Suleria, K., Mahesh, G., Singh, S., Peiser-Oliver, J., Mohammadi, S. A., & Vandenberg, R. J. (2025) · Journal of Medicinal Chemistry · doi:10.1021/acs.jmedchem.5c01126 · Cited by 9 · see citing works
Spector, A. L., Quinn, K. G., Wang, I., Gliedt, J. A., Fillingim, R. B., & Cruz‐Almeida, Y. (2023) · Chronic Stress · doi:10.1177/24705470231208281 · Cited by 9 · see citing works
Mauro, G. D., Sevel, L. S., Boissoneault, J., & Wang, Z. (2024) · Journal of Neuroscience Research · doi:10.1002/jnr.25341 · Cited by 9 · see citing works
Rosendo, L. M., Rosado, T., Zandonai, T., Rincon, K., Peiró, A. M., Barroso, M., & Gallardo, E. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25115925 · Cited by 8 · see citing works
Sex and gender differences in pain perception and management in clinical settings
Morgan, J., Magwood, K., Smith, J., Jenkins, M., McGregor, A. J., & Quesnelle, K. M. (2024) · All Life · doi:10.1080/26895293.2024.2367421 · Cited by 9 · see citing works
Huntsman, D. D., & Bulaj, G. W. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22020225 · Cited by 9 · see citing works
“For example, among US adults, 51.6 million experience chronic pain (2021 data [2]), 47 million have been diagnosed with depression (2020 data [3]), 40 million have migraine (2018 data [4]) and 16.9 million have anxiety (2018 data [5]).”
InfluentialYang, S., Wang, H., Tao, Y., Tian, J., Wen, Z., Cao, J., Zhang, W., Peng, S., & Zhang, X. (2025) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2025.105784 · Cited by 9 · see citing works
Khodir, S. A., Sweed, E. M., El-Haroun, H., Abd-el-Hamid, T., Derbaly, S. A. E., Mahmoud, A. R., & Motawea, S. M. (2025) · Scientific Reports · doi:10.1038/s41598-025-07209-w · Cited by 8 · see citing works
“It’s characterized by an aberrant and non-protective response 31 .”
Phenotyping Chronic Pain and Neuropathic Pain in Population Studies
Liang, I. J., Senaratne, D. N. S., & Smith, B. H. (2025) · European Journal of Pain · doi:10.1002/ejp.70146 · Cited by 8 · see citing works
“• Rikard et al. (2023) used a subsection of the National Health Interview Survey in the United States that sought to define chronic pain as pain on ‘most days or every day’ (rather than ‘never or some days’) during the previous 3 months.”
Medical Cannabis and Opioid Receipt Among Adults With Chronic Pain
Slawek, D. E., Zhang, C., Dahmer, S., Sohler, N., Zolotov, Y., Starrels, J. L., Deng, Y., DiFrancesca, G. C., LEVIN, F. R., Ross, J., et al. (2025) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2025.6496 · Cited by 8 · see citing works
Oxytocin Modulation in Mindfulness-Based Pain Management for Chronic Pain
Aygün, O., Mohr, E., Duff, C., Matthew, S., & Schoenberg, P. L. A. (2024) · Life · doi:10.3390/life14020253 · Cited by 10 · see citing works
“Chronic pain, defined as the experience of pain on a scale of 3/10 in severity for more than 3-months, presents a significant healthcare challenge, impacting around 20% of European and American populations [1–3].”
BackgroundImaging of pain using positron emission tomography
Zhou, Y., Zhang, L. L., Sun, Y., & Brugarolas, P. (2024) · iRadiology · doi:10.1002/ird3.73 · Cited by 7 · see citing works
Pain Phenotypes and Pain Multimorbidity Among Medicare Beneficiaries With Cerebral Palsy
Peterson, M. D., Ashbaugh, K., O’Leary, M., Schmidt, M. M., Haapala, H. J., Kamdar, N. S., & Hurvitz, E. A. (2024) · JAMA Neurology · doi:10.1001/jamaneurol.2024.2443 · Cited by 7 · see citing works
Mazurenko, O., O’Brien, E., Beug, A., Smith, S. M., & McCarthy, C. (2024) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.14118 · Cited by 7 · see citing works
Rubenstein, D., Green, M. J., Sweitzer, M., Keefe, F., & McClernon, F. (2024) · Pain · doi:10.1097/j.pain.0000000000003381 · Cited by 6 · see citing works
Wu, P., Chen, X.-X., Wang, S., Chen, X.-X., & Liu, J. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119630 · Cited by 9 · see citing works
MicroRNA-Based Delivery Systems for Chronic Neuropathic Pain Treatment in Dorsal Root Ganglion
Jackson, S., Gigliobianco, M. R., Casadidio, C., Martino, P. D., & Censi, R. (2025) · Pharmaceutics · doi:10.3390/pharmaceutics17070930 · Cited by 7 · see citing works
“Additionally, around 20–25% of the global population experiences chronic pain, and 20% of adults in Western countries report it as a major health concern [2–6].”
Laigaard, J., Aljuboori, S. M. S., Nikolajsen, L., Mathiesen, O., Lunn, T. H., & Overgaard, S. (2025) · The Journal of Arthroplasty · doi:10.1016/j.arth.2025.09.057 · Cited by 7 · see citing works
McMullan, J. T., Droege, C. A., Chard, K. M., Otten, E. J., Hart, K. W., Lindsell, C. J., & Strilka, R. J. (2024) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2024.04.018 · Cited by 7 · see citing works
Rhudy, J. L., Kell, P. A., Brown, T. V., Ventresca, H. M., Vore, C. N., Trevino, K. N., Jones, B. W., Lowe, T. S., & Shadlow, J. O. (2024) · Pain · doi:10.1097/j.pain.0000000000003442 · Cited by 7 · see citing works
Ciacchini, R., Conversano, C., Orrù, G., Scafuto, F., Sabbatini, S., Paroli, M., Miniati, M., Matiz, A., Gemignani, A., & Crescentini, C. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21111507 · Cited by 7 · see citing works
“According to recent research spanning from 2019 to 2021, the prevalence of CP among U.S. adults peaked at 21.8%, with high-impact CP accounting for 7.8% [69].”
InfluentialWooden, S. (2024) · Critical Care Nursing Clinics of North America · doi:10.1016/j.cnc.2024.04.008 · Cited by 7 · see citing works
Neurosurgical Intervention for Nerve and Muscle Biopsies
Mohamed, A. A., Caussat, T., Mouhawasse, E., Ali, R., Johansen, P. M., & Lucke-Wold, B. P. (2024) · Diagnostics · doi:10.3390/diagnostics14111169 · Cited by 6 · see citing works
“Chronic pain affects 20.9% of all adults in the United States, [1] reduced muscle strength is reported by 18% of those 60 years and above and 53% of those 80 and above, [2] and peripheral neuropathy, a common cause of numbness and paresthesia, affects over 14.5 million Americans [3].”
BackgroundInfluential
- Authors
- Rikard, S. M., Strahan, A. E., Schmit, K. M., & Guy, G. P.
- Affiliations
- National Center for Injury Prevention and Control (US)
- Corresponding author
- Rikard, S. Michaela
- Venue
- MMWR. Morbidity and Mortality Weekly Report
- Published
- 2023-04-14
- Volume
- 72
- Issue
- 15
- Pages
- 379-385
- ISSN
- 0149-2195 (ISSN-L)
- 1545-861X
- PMC
- PMC10121254
- OpenAlex
- W4365442769
- Cited by
- 588
- References
- 8
- Citations by year
- 2026: 144 · 2025: 265 · 2024: 143 · 2023: 35
- FWCI
- 91.10
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- MMWR Morbidity and Mortality Weekly Report (publishedVersion)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- chronic pain, high-impact chronic pain, prevalence, adults, health disparities, American Indian and Alaska Native adults, bisexuals, marital status, socioeconomic status, pain management, National Health Interview Survey, health equity
- MeSH terms
- Adult, Health Status, Humans, Population Surveillance, United States, Prevalence, American Indian or Alaska Native, Chronic Pain, Pain Management
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