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Last updated: Fri, May 31, 2024
Epidemiology is the study of diseases in groups of people. Epidemiologists study who is sick, where, and when, and look for patterns that may be useful for setting policy about public health or for understanding the conditions under which disease tends to occur. Wikipedia has a fairly detailed explanation of the science. In this section I'll review some epidemiology data about how common (prevalent) chronic pain is in the populations of wealthy countries like ours.
Troubling pain is very common. The Mayo Clinic in a 2001 survey found that "[n]early 50% of Americans see a physician with a primary complaint of pain each year."1 A different study reported that pain "accounts for approximately 80% of physician visits and an estimated US$100 billion annually between healthcare expenditures and lost productivity...."2 Pain as the only complaint accounts for 2.3% of physician visits, or 17.4 million visits/year, as of 2001, according to review of physician records.3 Although these estimates differ, they all paint the same general picture; pain is common and expensive.
How expensive is pain? "Considering all sources of expenditures, chronic pain is projected to cost the U.S. economy roughly $100 billion each year ('Employer Health Care Strategy Survey,' 2003; Washington Business Group on Health and Watson Wyatt Worldwide, 2003). Lost productive time from common pain conditions among workers cost an estimated $61.2 billion/year. The majority (76.6%) of the lost productive time was explained by reduced performance while at work, not work absence....."4 Such numbers are estimates and can be based on rather loose assumptions. You can evaluate the surveys if you wish by referring to the sources. My own experience in management science makes me suspicious especially of estimates of "reduced performance at work." Consider also that such studies are conducted in order to affect public policy in one way or another. Nevertheless, these numbers are large, and, like many medical policy issues, don't treat the suffering or the incidental costs of the sick as denominated in dollars.
The most common varieties of chronic pain are back pain; myofascial pain, whiplash, and fibromyalgia; neuropathic pain; headache; and pain associated with cancer.5 (Myofascial pain is pain of the muscles and fascia.) A 2006 survey of individuals from fifteen European countries plus Israel found that 19% of the respondents had pain for at least six months and had experienced pain in the last month and several times during the last week. By body part the prevalance of pain was: Head 15%, Neck 8%, Upper back 5%, Hip 8%, Lower back 18%, Shoulder 9%, Hand 6%, Leg 14%, Knee 16%, unspecified Joints 10%, unspecified Back 24%.6
Interestingly, there are few types of pain that are believed to originate in the muscles themselves. More commonly the category of "myofascial pain" (MFP) is used, which refers to pains originating in either the muscles, the fascia, or both. There aren't agreed symptoms and signs that define MPS or myofascial pain syndrome. Nevertheless, "research indicates a high prevalence of MFP [myofascial pain] among various patient populations, with rates ranging from 30% among patients in a general medical clinic to 85% among patients treated at a pain center."7
Low back pain (LBP), acute or chronic, is often classified as a "musculoskeletal pain syndrome," but also fits our definition of myofascial pain. It occurs for many reasons, some known and diagnosable, others mysterious. Studies have estimated that between 58 and 84% of the population will report LBP to their doctors at some point in their lives. Between 18-50% of people will have LBP in a given year. It is more common in females, and is most common around age sixty. Its prevalence then declines.8
The prevalence of new LBP in adults is estimated at about 5% of the population per year. As many as 20% of 12-15 year olds reported in a survey that they had experienced LBP within the past monsth. LBP symptoms among children are unlikely to be disabling, and few children report back pain to their doctors. However, a study of some 300 kids originally aged 11-14 found about one-quarter still had LBP symptoms after four years.9
Chronic low back is less common. A study in the UK's general population found that from 6% to 11% experienced chronic LBP at some point in their life.10
The National Academies of Science and the Institute of Medicine made an estimate of the costs of LBP in 2001. They found that the total "financial impact" was from $45 to $54 billion per year, including lost productivity, lost wages, loss in household services, and tax revenues.11
A study in the UK found that 20% of men and 24% of women experienced foot pain each month. Prevalence was highest in the age range 55-64, and then decreased slightly. Disabling foot pain was found in 8% of men and 11% of women.12
Studies of hip pain in the Netherlands and the US have shown one-month prevalence of 9% to 13%. Another US study found a six-week prevalence of 14%, and a UK study showed that 14% had experienced hip pain "on most days for one month or longer" over the length of a year. Prevalence of hip pain also seems to peak around age 60.13
Arthritis pain includes a broad range of conditions ranging from autoimmune to joint degradation. A 2002 study concluded that $12.5 billion was spent each year in medical treatment of arthritis in the United States. Lost production, according to this study, cost over $7 billion. Two-thirds of that cost was attributed to "pain exacerbations."14
A study that combined data from over one hundred other studies showed that about two-thirds of us experience headache during their lifetime, while 14% experience migraine. Earlier studies had shown that about half of people experience headache in a given year, and almost 14% experience migraine. Headache is high among teenagers and into early adulthood. It is higher among females than among males. Migraines are slightly more common among females, and among those females 30 to 49 years old.15
A 2005 study done by the National Headache Foundation found that 45 million Americans have chronic headaches. They estimated losses due to headache at $50 billion per year, made up of absenteeism and medical costs, and $4 billion for over-the-counter medications.16
Chronic Widespread Pain (CWP) is a medical label used to designate widespread pain of a myofascial nature that is not otherwise diagnosed. Fibromyalgia Syndrome is a specify pattern of myofascial pain. FMS sufferers commonly experience other co-morbidities, including chronic sleep dysfunction (insomnia and non-restful sleep), headache, stiffness, fatigue, cognitive dysfunction, and psychiatric conditions such as depression and anxiety.17
A 2009 study reported that 5-10% of the population experience chronic widespread pain during their lifetime. A 2008 study reported that five million Americans over age eighteen have fibromyalgia. (This would be somewhat less than 2%.)18 FMS is four to seven times more common among women than men, and is most common in peoples' sixties.19
Estimates of one-month prevalence of abdominal pain have been published ranging from 7 to 18%, depending on the inclusion of "Rome I" conditions.20 (See Rome process in Wikipedia.)