The Demography of Chronic Pain: A Population Approach to Pain Trends, Pain Disparities, and Pain-Related Disability and Death

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PROJECT SUMMARY / ABSTRACT This project on the Demography of Chronic Pain will use demographic data, methods, and theories to comprehensively investigate high-priority questions about chronic pain's prevalence, distribution, long-term trends, precursors, and consequences. The project's long-term goal is to enhance U.S. public health by greatly expanding the scientific knowledge base regarding patterns and trends in chronic pain, pain's links to disability and mortality, and individual and population-level factors that could reduce the burden of pain. Through quantitative analyses of large, longitudinal or repeated cross-sectional datasets (primarily American, but also Canadian and European for comparative purposes), this research will advance four specific aims: • Aim 1: To identify national and regional trends in the prevalence and social distribution of chronic pain. • Aim 2: To identify individual-level and contextual factors shaping temporal and social patterns in pain. • Aim 3: To theoretically and empirically integrate chronic pain into models of disability. • Aim 4: To investigate the association between chronic pain and mortality. This research is significant and timely because chronic pain is one of the country's most common, costly, and disabling health problems, with a strikingly unequal social distribution. Chronic pain is also implicated in many of the most troubling contemporary U.S. health trends, including the opioid epidemic, rising suicide rates, increasing mid-life disability and mortality, and growing educational inequalities in health and mortality. Pain is thus both a major problem in its own right, and a potential missing link in recent adverse trends in U.S. population health more broadly. This research is innovative because the field of demography has nearly completely neglected the topic of chronic pain, even though pain is a (perhaps the) leading cause of disability, a powerful predictor of mortality, and a major contributor to social disparities in health. Little is known about long-term trends in pain or pain disparities, cross-national differences in such trends, individual or contextual (regional or national) factors shaping such trends, the role of pain in development of disability, or pain's contributions to mortality patterns. This project will establish a new subfield within the demography of health and aging that investigates these topics. Findings will clarify how health policies and practices can best prevent and address chronic pain, support healthy aging, and enhance overall U.S. population health.