We, The People, Are in Pain

October 7, 2015

Chronic PainThe news is in: we, the people, are in pain. According to a major new study from the National Institutes of Health (NIH) published last month in a scholarly journal entitled, appropriately, the Journal of Pain, 50 million Americas have significant chronic or severe pain.1

A subset of this group — 39.8 million American adults — experience either category 3 or 4 pain, the highest levels defined. Researchers write that people with this kind of pain are “likely to have worse health status, use more health care, and suffer from more disability than those with less severe pain.”

This is an almost mind-boggling number: nearly 1 in 5 American adults. It’s so large you might be tempted to dismiss it, but it matters. Data like this will not only affect public policy — including healthcare laws, taxes, and the GDP — it also means pain is likely to affect you personally, either physically or by debilitating someone you know or love.

Terms of Pain

This study marks a good occasion to define some of the terms that are often brought up in discussions of pain. There are three general pain categories to remember:

Acute Pain.

Acute pain typically follows some sort of injury: for example, a burst appendix or a fall. This type of pain is very useful. It’s our body’s way of telling us that something is wrong and should be addressed. This pain also starts a wave of changes inside the body to attempt to deal with the pain and to repair what has been damaged. This process is often called “The Cascade of Pain.” 

Severe Pain.

Severe pain is a very general category that arguably lacks an exact definition, but it is typically taken to mean the kind of pain that is not due to an immediate injury, but — when it comes — disrupts daily activity. Migraines and back spasms are good examples here.

Chronic Pain.

Chronic pain is typically defined as pain that lasts for more than 3-6 months, or after the healing of a known injury is complete. Dr. Daniel Gruener, a professor at Jefferson Medical College in Philadelphia, offers this useful elaboration: “chronic pain serves no useful function, persisting beyond the time one would expect normal healing to occur.”2

A Few Examples the Appendix, the Back, the Head

It is important to note that some of these painful conditions can feed into one another, or can be isolated. To use the examples already mentioned, the acute pain of a burst appendix, if treated, should completely resolve, causing no further pain at all.

By contrast, chronic back pain may follow an injury, or it may seemingly arise out of nowhere. It may be complete with episodes of acute or severe pain, or it may slowly develop into pain that is unbearable not because of its severity but because of its persistence. Often with back pain, a spinal disc may slip or degenerate, leading to the gradual entrapment of a nerve. You may not feel this process at all, or you may feel a nagging little pinch. Either way, the changes happening in your spine may end up causing some real pain that just will not go away — this is chronic pain.

Migraines are a great example of chronic pain that has no known cause – no injury, no underlying disease, no known development. One day, you’re going along just fine. The next day, you’re hit with a migraine and suffer them — chronically — for many years.

A Paradox and a Couple Questions

The NIH study revealed a strange paradox and brings up an interesting question. The paradox is: many people with Category 3 or 4 pain reported their overall health as “good.” Related to this, men and Asians were less likely to report pain than women and non-Asians.

The questions these findings raise are: How can your health be good if you are in pain? Do women actually experience more pain, or do they feel it is more culturally acceptable to say they have it? Are men just trying to “tough it out”? Is there something about chronic pain that makes a person more likely to just live with it and not seek out medical care, as if pain is just a fact of life?

The Importance of Treating Pain

The importance of treating pain is obvious. Increase your quality of life! Better your mood and your relationships! Focus more on work and play! Save money on Advil!

But there is a less obvious reason to treat pain — and to treat it as quickly and comprehensively as possible — and that is that so much of it is progressive. It can worsen over time, and it can bring on other painful conditions.

To stick with our three examples: untreated appendicitis can kill you. That’s an easy one. An entrapped nerve in your back can not only worsen, it can lead to compensations in other parts of the body, like the hips, knees, and ankles. The unnaturally apportioned weight your lower body may carry to compensate for the pain in your back may begin causing injuries in those areas. Migraines, of course, can seriously inhibit your ability to get enough physical exercise and can impede your ability to develop and maintain healthy relationships. And all of the above can lead to the big Ds: depression, diabetes, and dependence, which can bring pain and hardship to whole new levels.

The Takeaway

Coming up with a statistic like “50 million American adults suffer significant pain” is no easy feat, and, admittedly, this statistic relies on self-reporting. But more difficult to answer still is why so many people try to “tough it out” or “play through.” That might be okay for a gym session or a round of golf, but pain is usually signaling something.

Or, to go back to Dr. Gruener’s definition — especially applicable in the examples of back and migraine pain — chronic pain may not be signaling anything at all except bad luck (as every migraineur knows), and yet it may lead to further pain down the road. Playing through the pain during a round of golf may be a mind-over-matter situation. But when pain is chronic, matter usually beats the mind.

Too many of us are needlessly suffering, and that causes us all to suffer. We, the people, might need a kick in the pants to deal with the pain in our backs.


  1. Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. Journal of Pain.2015;16(8):769-780.
  2. Gruener DM. New strategies for managing acute pain episodes in patients with chronic pain. Medscape Neurology. 2004;6(2)

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