P F I Z E R
F A C T S
The Burden of Pain
Among Adults
in the United States
Findings from the National Health and Nutrition Examination Survey,
the National Health Care Surveys, and the National Health Interview Survey
Medical Division
PG283560
© 2008 Pfizer Inc. All rights reserved.
Printed in USA/December 2008
The burden of pain among adults in the
United States
O
ver 100 million adults in the United States—51% of the estimated 215 million
population aged 20 years and older—report pain at one or more body sites including
the joints, low back, neck, face/jaw, or experience dental pain or headaches/migraines.
Over one-quarter of adults aged 40 years and older report low back pain in the past
3 months. One-quarter of women aged 20–39 years report having severe headaches or migraines
in the past 3 months.
Numerous diseases and conditions are also associated with pain, including arthritis, peripheral
neuropathy, fibromyalgia, and shingles. Annually, there are 5.4 million ambulatory and inpatient
health care visits with a diagnosis of fibromyalgia, 1.9 million diabetic neuropathy visits, and 1.5
million shingles visits. 50% of adults with diabetes who have peripheral neuropathy report
symptoms of pain/tingling in their feet or numbness/loss of feeling in the past 3 months. 44% of
adults with arthritis report limitations in their usual activities due to their arthritis or joint pain.
Pain may also be caused by bodily injury or harm. In 2006, there were approximately 34 million
injury-related physician office visits. Analgesic drug therapy was reported at 40% of these injuryrelated visits.
Adults with pain have worse health status and experience more disability in terms of lost work
days, activity limitations, reduced sleep, and increased psychological distress than adults without
pain. One in 3 adults with face or jaw pain report fair or poor health status, nearly 1 in 5 adults
with neck pain report being unable to work, and 1 in 9 adults with severe headaches/migraines
report psychological distress.
This issue of Pfizer Facts presents new analyses of national data sources to gain insight into the
burden of pain among adults in the United States. We present information on the prevalence of
pain at specific body sites and certain pain-related diseases and conditions such as arthritis,
peripheral neuropathy, fibromyalgia, and shingles, as well as information on associated health
status and health care resource utilization. We present analyses of the National Health Interview
Survey (NHIS), the National Health Care Surveys, and the National Health and Nutrition
Examination Survey (NHANES). We provide this information in an effort to heighten awareness
and encourage discussion pertaining to pain among adults.
Ryne Paulose, PhD
Director
Robin P. Hertz, PhD
Senior Director/Team Leader
Comparative Effectiveness &
Population Studies
Evidence-Based Strategies
Table of contents
Highlights
1
Pain at selected body sites
7
Joint pain
Low back pain
Neck pain
Severe headaches or migraines
Dental pain
Face or jaw pain
Pain and selected diseases or conditions
Arthritis
Peripheral neuropathy
Diabetic neuropathy
Fibromyalgia
Shingles
Injury
Appendix
9
25
37
47
57
58
61
61
73
75
79
83
87
91
The burden of pain among adults in the United States
Highlights
Pain at selected body sites
• Over one-half of adults aged 20 years and older report feeling pain at one or
more body locations including the joints, back, neck, head, mouth, or face/jaw.
Joint pain (28%) and low back pain (26%) are most prevalent.
• Joint pain increases with age and is generally more prevalent among women
(31%) than men (26%), and among white, non-Hispanic adults (31%), than
black, non-Hispanic adults (26%) and Hispanic adults (18%). 29% of adults
with joint pain report having severe pain. The knee is the most common site of
joint pain regardless of age or gender.
• One in 3 older women and 1 in 4 older men report low back pain in the past 3
months. Prevalence increases with body weight—low back pain is reported by about
1 in 5 normal weight adults, 1 in 4 overweight adults, and 1 in 3 obese adults.
• 13% of adults report neck pain in the past 3 months. Neck pain is reported
more often by women (15%) than men (11%) and white, non-Hispanic adults
(14%) then black, non-Hispanic adults (10%) or Hispanic adults (11%).
• One in 8 adults report severe headaches or migraines in the past 3 months. It is
more prevalent among women (17%) than men (7%) and adults aged 20–39
(15%) and 40–64 (13%) years than adults 65 and older (5%).
• One in 8 adults report dental pain in the past year. Men and women have a
similar prevalence of dental pain regardless of age.
• 4% of adults report facial ache or pain in the jaw muscles or the joint in front
of the ear. Regardless of age, more women (6%) than men (2%) report having
this type of pain.
Pain at selected body sites and health status
• 25–33% of adults with pain at selected body sites report fair or poor health,
15–22% report being unable to work, 12–17% report sleeping less than 6 hours
per day, and 6–13% report psychological distress.
• Also, 29–39% of adults with joint pain, low back pain, and neck pain report
arthritis-attributable activity limitations.
1
The burden of pain among adults in the United States
Pain at selected body sites and health care utilization
• Annually, adults have an average of 11 million physician office visits with a
diagnosis of joint pain, over 1.1 million outpatient hospital visits, about 1.5 million
emergency department visits, and have over 177 thousand inpatient hospitalizations.
• Annually, adults have an average of 7 million physician office visits with a
diagnosis of back pain, 762 thousand outpatient hospital visits, over 1.5 million
emergency department visits, and have about 227 thousand inpatient
hospitalizations.
• Annually, adults have an average of 11 million physician visits with a headache
diagnosis, over 1 million outpatient hospital visits, 3.3 million emergency
department visits, and 445 thousand inpatient hospitalizations.
• The majority of health care utilization for joint pain, back pain, and headaches
was by women and white, non-Hispanic adults.
Pain at selected body sites and analgesic drug use
• 23–27% of adults with joint pain, low back pain, neck pain, or severe
headaches/migraines report prescription analgesic drug use in the past month.
• 15–22% of adults with joint pain, low back pain, neck pain, or severe
headaches/migraines report using a non-prescription analgesic or certain
non-narcotic prescription analgesics nearly every day for a month or longer.
2
The burden of pain among adults in the United States
Pain and selected diseases or conditions
Arthritis
• 22% of adults aged 20 years and older have been told by a physician or health
professional that they have arthritis.
• It is more common among women (25%) than men (18%), older age groups
(48%, 65 and older; 25%, 40–64 years) than younger (6%, 20–39 years), and
white, non-Hispanic adults (25%) than black, non-Hispanic (19%) and
Hispanic (12%) adults.
• Arthritis is also more common among obese (30%) or overweight (21%) adults
than normal weight adults (16%).
• 31% of adults with arthritis report fair or poor health compared to 9% of
adults without arthritis. Adults with arthritis are also 11 times more likely to
report arthritis-attributable activity limitations, 5 times more likely to report
being unable to work, nearly twice as likely to report reduced hours of sleep,
and 3 times as likely to report psychological distress.
• 37% of adults with arthritis report prescription analgesic drug use and 31% use
a non-prescription or non-narcotic prescription analgesic nearly every day for a
month or longer.
Peripheral Neuropathy
• 14% of adults aged 40 years and older have peripheral neuropathy; three-fourths
experience no related symptoms of pain/tingling or numbness in their feet.
• Adults with diabetes have twice the prevalence of peripheral neuropathy as
those with no diabetes (28% vs. 11%, respectively).
• 50% of adults with diabetes who have peripheral neuropathy are symptomatic
compared to less than 20% among adults with no diabetes.
3
The burden of pain among adults in the United States
Diabetic Neuropathy
• Annually, adults have an average of 1.4 million physician office visits with a
diagnosis of diabetic neuropathy, 132 thousand outpatient hospital visits, 40
thousand emergency department visits, and 392 thousand inpatient
hospitalizations.
• The majority of ambulatory and inpatient visits for diabetic neuropathy are by
women (46–65%), adults aged 40–64 (46–57%), and white, non-Hispanic
adults (54–70%).
• An analgesic drug was prescribed, administered, or continued at 37% of
physician office visits with a primary diagnosis of diabetic neuropathy.
Fibromyalgia
• Annually, there are about 5.4 million health care visits with a fibromyalgia
diagnosis: 4.5 million physician office visits, 390 thousand outpatient hospital
visits, 413 thousand emergency department visits, and 157 thousand inpatient
hospitalizations.
• The majority of this health care utilization is by women, adults aged 40–64 years,
and white, non-Hispanic adults. However, emergency departments have relatively
more visits by men, adults aged 20–39, and black, non-Hispanic adults.
• An analgesic drug was prescribed, administered, or continued at 71% of the
physician office visits with a primary diagnosis of fibromyalgia; 29% of office
visits had an antidepressant drug mention and 14% had an anxiolytic, sedative,
or hypnotic drug mention.
4
The burden of pain among adults in the United States
Shingles
• Annually, adults have about 1.2 million physician office visits and 33 thousand
inpatient hospitalizations with a diagnosis of shingles.
• The majority of health care visits are by women, adults aged 40–64 years, and
white, non-Hispanic adults, with the exception of inpatient hospitalizations
where over two-thirds are by adults aged 65 and older.
• At over half of all physician office visits with a primary diagnosis of shingles,
an analgesic drug was prescribed, administered, or continued.
Injury
• There are ~34 million injury-related physician office visits because of body
sprains or strains, fractures, contusions, dislocations, crushes, or burns.
• Sprains and strains are most common (~17 million office visits), followed by
fractures (8 million) and contusions (7 million).
• Analgesic drugs are prescribed, administered, or continued at 40% of injuryrelated physician office visits.
5
The burden of pain among adults in the United States
Pain at selected body sites
51% of all adults aged 20 years and older report feeling pain at a joint, their
back, neck, head, mouth, or face/jaw. Joint pain and low back pain are most
prevalent (28% and 26%, respectively).
Prevalence of pain at selected body sites among adults
Any pain
51
28
Joint
Low back
26
Neck
13
Headache/
migraine
12
Dental
12
4
Face/jaw
0
10
20
30
40
50
Percent of adult population
Source: NHIS 2007
The Any pain category includes all other pain sites listed. Joint pain prevalence is in the past month; Dental pain is in the past year;
all other body sites are in the past 3 months.
Bars with the same values may have different lengths because of rounding.
7
60
The burden of pain among adults in the United States
Joint pain
28% of adults report joint pain, aching, or stiffness in the past month. Joint pain
increases with age: 15% among adults aged 20–39 years; 34% among adults aged
40–64 years; 44% among those aged 65 and older. Nearly 50% of older women
(47%) and older black, non-Hispanic adults (47%) report joint pain.
Prevalence of joint pain in the past month among adults, by gender and age
Age, years
28
Total
26
31
15
15
15
20–39
34
40–64
31
37
44
39
65+
47
10
0
20
30
40
50
Percent of adults
Total
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Prevalence of joint pain in the past month among adults, by race/ethnicity and age
Age, years
31
Total
26
18
17
20–39
12
9
35
40–64
34
27
45
47
65+
38
0
10
Percent of adults
Source: NHIS 2007
9
20
30
40
50
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
One in 4 men and 1 in 3 women with joint pain report having severe pain.
Black, non-Hispanic (44%), and Hispanic (41%) adults with joint pain report
more severe pain than white, non-Hispanic adults who have joint pain (26%).
Prevalence of severe pain among adults with joint pain
Total
29
Men
26
Women
33
White,
non-Hispanic
Black,
non-Hispanic
26
44
Hispanic
41
12
0
10
20
Percent of adults with joint pain
Source: NHIS 2006
Bars with the same values may have different lengths because of rounding.
10
30
40
50
The burden of pain among adults in the United States
Weight is associated with joint pain—22% among normal weight adults; 28%
among overweight adults; 37% among obese adults.
Prevalence of joint pain in the past month among adults, by body weight and gender
22
28
Total
37
22
26
Men
31
23
31
Women
43
0
10
20
30
40
50
Normal
Overweight
Obese
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Prevalence of joint pain in the past month among adults, by body weight and race/ethnicity
25
White,
non-Hispanic
31
42
19
Black,
non-Hispanic
25
33
13
Hispanic
19
24
0
10
Percent of adults
Source: NHIS 2007
11
20
30
40
50
Normal
Overweight
Obese
The burden of pain among adults in the United States
The knee is the most common site of joint pain regardless of age or gender. This is
followed by the shoulder for men aged 40 years and older.
Prevalence of joint pain at specific body sites among men aged 20 years and older
by age groups
Shoulder
Total
20–39
40–64
65+
8
4
10
11
Elbow
Wrist
Total
20–39
40–64
65+
4
2
5
6
4
1
5
9
Ankle
Total
20–39
40–64
65+
5
4
6
6
Percent
Source: NHIS 2007
12
4
2
6
4
Fingers
Total
20–39
40–64
65+
Hip
Total
20–39
40–64
65+
Total
20–39
40–64
65+
5
2
6
9
Knee
Total
20–39
40–64
65+
15
8
18
23
Toes
Total
20–39
40–64
65+
2
1
3
3
The burden of pain among adults in the United States
After the knee, the fingers are the most common site of joint pain for women aged
65 years and older.
Prevalence of joint pain at specific body sites among women aged 20 years and older
by age groups
Shoulder
Total
20–39
40–64
65+
9
3
11
15
Elbow
Wrist
Total
20–39
40–64
65+
6
3
8
8
Hip
Total
20–39
40–64
65+
9
3
11
14
Ankle
Total
20–39
40–64
65+
7
4
8
8
Percent
Source: NHIS 2007
13
Total
20–39
40–64
65+
4
2
6
6
Fingers
Total
20–39
40–64
65+
9
2
11
17
Knee
Total
20–39
40–64
65+
18
9
22
29
Toes
Total
20–39
40–64
65+
3
1
4
6
The burden of pain among adults in the United States
Joint pain and health status
Joint pain is associated with substantial activity limitation, work disability, and
reduced quality of life. Adults with joint pain are more than 3 times as likely to
report fair/poor health than those with no joint pain (27% vs. 8%, respectively),
20 times more likely to report arthritis-attributable activity limitations, 4 times
as likely to report being unable to work, twice as likely to report reduced sleep
(<6 hours per day), and 3 times more likely to report psychological distress.
Prevalence of selected health status indicators among adults with or without joint pain
8
Fair/poor health
27
2
Limitation of activity due to
arthritis or joint symptoms
39
4
Unable to work
16
6
<6 hours of sleep
12
2
Psychological distress
6
0
10
20
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
14
30
40
No joint pain
Joint pain
The burden of pain among adults in the United States
Over one-half of Hispanic older adults with joint pain report fair or poor health
status (56%).
Percent of adults with joint pain who report fair/poor health status, by gender and age
Age, years
25
Total
29
12
20–39
19
25
40–64
28
38
65+
35
10
0
20
30
40
50
Percent of adults
Men
Women
Source: NHIS 2007
Percent of adults with joint pain who report fair/poor health status, by race/ethnicity
and age
Age, years
24
Total
39
35
13
20–39
20
21
23
40–64
43
35
34
47
65+
56
10
0
Percent of adults
Source: NHIS 2007
15
20
30
40
50
60
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
About half of all older adults with joint pain report arthritis-attributable activity
limitations.
Percent of adults with joint pain who report activity limitations because of arthritis or
joint symptoms, by gender and age
Age, years
36
Total
42
19
20–39
27
38
40–64
41
48
65+
52
10
0
20
30
40
50
Percent of adults
60
Men
Women
Source: NHIS 2007
Percent of adults with joint pain who report activity limitations because of arthritis or
joint symptoms, by race/ethnicity and age
Age, years
39
Total
45
37
24
20–39
23
20
38
40–64
48
39
50
58
65+
55
0
10
Percent of adults
Source: NHIS 2007
16
20
30
40
50
60
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
More younger adults with joint pain report reduced daily sleep hours (11–16%)
than older adults with joint pain (6–9%).
Percent of adults with joint pain who report less than 6 usual hours of sleep, by gender
and age
Age, years
12
12
Total
11
20–39
16
14
40–64
12
6
65+
9
0
2
4
6
8
10
12
14
16
Percent of adults
18
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Percent of adults with joint pain who report less than 6 usual hours of sleep, by
race/ethnicity and age
Age, years
10
18
Total
16
12
21
20–39
15
12
19
40–64
18
7
12
12
65+
5
0
10
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
17
15
20
25
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Nearly one-third of black, non-Hispanic adults aged 40–64 years with joint pain
report being unable to work.
Percent of adults with joint pain who report being unable to work, by gender and age
Age, years
15
Total
16
9
20–39
11
18
40–64
18
0
2
4
6
8
10
12
14
16
18
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
20
Men
Women
Percent of adults with joint pain who report being unable to work, by race/ethnicity
and age
Age, years
15
Total
26
17
10
20–39
12
10
16
40–64
31
20
0
5
10
15
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
18
20
25
30
35
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
More young women with joint pain experience psychological distress than young
men with joint pain (9% vs. 4%, respectively).
Percent of adults with joint pain who report psychological distress, by gender and age
Age, years
4
Total
7
4
20–39
9
5
40–64
8
2
65+
4
0
1
2
3
4
5
6
7
8
9
Percent of adults
10
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Percent of adults with joint pain who report psychological distress, by race/ethnicity
and age
Age, years
5
Total
6
10
7
20–39
6
8
6
40–64
8
12
3
3
65+
8
0
2
4
6
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
19
8
10
12
14
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Joint pain and health care utilization
In 2006, adults made over 11 million physician office visits with a diagnosis of
joint pain, over 1.1 million outpatient hospital visits, about 1.5 million emergency
department visits, and 177 thousand inpatient hospitalizations.
The majority of health care visits for joint pain were by women, adults aged
40–64 years, and white, non-Hispanic adults.
Percent of physician office visits among adults with a diagnosis of joint pain
42
25
48
20%
13
40%
20–39
40–64
65+
27
67
0%
Men
Women
58
60%
14
6
80%
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NAMCS 2006
Percent of outpatient hospital visits among adults with a diagnosis of joint pain
42
58
19
54
20%
40%
Source: NHAMCS 2006
Totals may not add to 100% because of rounding.
20
20–39
40–64
65+
26
73
0%
Men
Women
17
60%
80%
White, non-Hispanic
Black, non-Hispanic
Hispanic
10
100%
The burden of pain among adults in the United States
Percent of emergency department visits among adults with a diagnosis of joint pain
43
37
43
20%
26
40%
20–39
40–64
65+
20
58
0%
Men
Women
57
60%
12
80%
3
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NHAMCS 2006
Totals may not add to 100% because of rounding.
Percent of inpatient hospitalizations among adults with a diagnosis of joint pain
37
15
34
20%
0%
20–39
40–64
65+
50
40%
Source: NHDS 2006
Totals may not add to 100% because of rounding.
21
Men
Women
63
60%
80%
100%
The burden of pain among adults in the United States
Joint pain and analgesic drug use
24% of adults with joint pain report prescription analgesic drug use in the past
month.
22% of adults with joint pain report using a non-prescription analgesic or certain
non-narcotic prescription analgesics nearly every day for a month or longer.
Prevalence of prescription analgesic drug use in the past month among adults with
joint pain in the past year, by gender and age
Age, years
24
Total
19
28
16
20–39
10*
22
25
40–64
21
29
31
29
65+
33
0
5
10
15
Percent of adults with joint pain
Source: NHANES 2003–2004
*Estimate is unreliable due to small sample size.
Bars with the same values may have different lengths because of rounding.
22
20
25
30
35
Total
Men
Women
The burden of pain among adults in the United States
Prevalence of frequent monthly use of non-prescription and select prescription
analgesics among adults with joint pain in the past year, by gender and age
Age, years
22
Total
19
24
10
20–39
7*
12*
22
40–64
20
23
38
40
65+
37
0
5
10
15
Percent of adults with joint pain
Source: NHANES 2003–2004
*Estimate is unreliable due to small sample size.
23
20
25
30
35
40
45
Total
Men
Women
The burden of pain among adults in the United States
Low back pain
Over one-quarter of adults report low back pain in the past 3 months (26%). One
in 3 older women and 1 in 4 older men report low back pain.
Prevalence of low back pain in the past 3 months among adults, by gender and age
Age, years
26
Total
24
28
22
20–39
20
24
28
40–64
27
29
30
25
65+
33
5
0
10
15
20
25
30
Percent of adults
35
Total
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Prevalence of low back pain in the past 3 months among adults, by race/ethnicity and age
Age, years
28
Total
23
23
25
20–39
18
19
28
40–64
27
28
30
65+
27
27
5
0
10
15
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
25
20
25
30
35
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Low back pain increases as body weight increases—about 1 in 5 normal weight
adults, 1 in 4 overweight adults, and 1 in 3 obese adults report low back pain.
Prevalence of low back pain in the past 3 months among adults, by body weight and
gender
22
25
Total
33
21
24
Men
28
23
27
Women
38
0
10
20
30
40
Normal
Overweight
Obese
Percent of adults
Source: NHIS 2007
Prevalence of low back pain in the past 3 months among adults, by body weight and
race/ethnicity
24
28
Total
34
20
20
Men
29
20
21
Women
30
0
10
20
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
26
30
40
Normal
Overweight
Obese
The burden of pain among adults in the United States
Low back pain and health status
Adults with low back pain are nearly 3 times as likely to report fair or poor
health than those without back pain (26% vs. 9%, respectively), more than 4
times as likely to report arthritis-attributable activity limitations, 4 times as likely
to be unable to work, twice as likely to report reduced sleep (<6 hours per day),
and 7 times more likely to report psychological distress.
Prevalence of selected health status indicators among adults with or without low back pain
9
Fair/poor health
26
7
Limitation of activity due to
arthritis or joint symptoms
29
4
Unable to work
15
6
<6 hours of sleep
13
1
Psychological distress
7
0
10
Percent of adults
Source: NHIS 2007
27
20
30
No low back pain
Low back pain
The burden of pain among adults in the United States
Self-rated fair or poor health is reported by about one-half of black, non-Hispanic
adults aged 40 years and older and 58% of Hispanic adults aged 65 years and
older with low back pain.
Percent of adults with low back pain who report fair/poor health status, by gender and
age
Age, years
25
Total
27
9
20–39
15
29
40–64
31
43
65+
38
10
0
20
30
40
50
Percent of adults
Men
Women
Source: NHIS 2007
Percent of adults with low back pain who report fair/poor health status, by
race/ethnicity and age
Age, years
24
Total
39
27
10
20
20–39
13
26
49
40–64
34
38
51
65+
58
0
10
Percent of adults
Source: NHIS 2007
28
20
30
40
50
60
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Arthritis-attributable activity limitations are reported by 50% of older women and
about 60% of older black, non-Hispanic, and Hispanic adults with low back pain.
Percent of adults with low back pain who report activity limitations because of arthritis
or joint symptoms, by gender and age
Age, years
26
Total
32
9
20–39
12
31
40–64
38
44
65+
50
0
10
20
30
40
50
Percent of adults
60
Men
Women
Source: NHIS 2007
Percent of adults with low back pain who report activity limitations because of arthritis
or joint symptoms, by race/ethnicity and age
Age, years
30
Total
34
23
12
20–39
9
5
34
44
40–64
32
46
57
60
65+
10
0
Percent of adults
Source: NHIS 2007
29
20
30
40
50
60
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Reduced daily sleep hours are reported by 1 in 5 black, non-Hispanic adults with
low back pain, 1 in 7 Hispanic adults, and 1 in 9 white, non-Hispanic adults.
Percent of adults with low back pain who report less than 6 usual hours of sleep, by
gender and age
Age, years
12
Total
13
10
20–39
13
16
40–64
15
6
65+
9
0
2
4
6
8
10
12
14
16
18
Percent of adults
Men
Women
Source: NHIS 2007
Percent of adults with low back pain who report less than 6 usual hours of sleep, by
race/ethnicity and age
Age, years
11
Total
20
14
11
20–39
18
11
13
40–64
22
18
7
13
65+
12
5
0
10
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
30
15
20
25
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
About 1 in 5 adults aged 40–64 years with low back pain report being unable to
work regardless of gender or race-ethnicity. The exception is black, non-Hispanic
adults aged 40–64 years, where over one-third of those with low back pain report
being unable to work (35%).
Percent of adults with low back pain who report being unable to work, by gender and age
Age, years
14
Total
16
5
20–39
8
19
40–64
22
0
5
10
15
20
25
Men
Women
Percent of adults
Source: NHIS 2007
Percent of adults with low back pain who report being unable to work, by race/ethnicity
and age
Age, years
14
Total
25
12
7
20–39
10
5
19
40–64
35
5
0
10
15
19
20
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
31
25
30
35
40
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Older Hispanic adults with low back pain are about 3 times more likely to report
psychological distress (12%) than older white, non-Hispanic (4%) and black,
non-Hispanic (5%) adults with low back pain.
Percent of adults with low back pain who report psychological distress, by gender and age
Age, years
5
Total
8
4
20–39
7
6
40–64
10
3
65+
5
0
2
4
6
8
10
12
Percent of adults
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Percent of adults with low back pain who report psychological distress, by race/ethnicity
and age
Age, years
6
Total
8
8
6
20–39
6
5
7
11
11
40–64
4
5
65+
12
2
0
4
6
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
32
8
10
12
14
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Low back pain and health care utilization
In 2006, adults made about 7 million physician office visits with a diagnosis of
back pain, 762 thousand outpatient hospital visits, over 1.5 million emergency
department visits, and 227 thousand hospitalizations.
The majority of health care visits for back pain were by women, adults aged
40–64 years, and white, non-Hispanic adults.
Percent of physician office visits among adults with a diagnosis of low back pain
45
Men
Women
55
22
59
76
20%
0%
40%
20–39
40–64
65+
19
15
60%
6
80%
2
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NAMCS 2006
Totals may not add to 100% because of rounding.
Percent of outpatient hospital visits among adults with a diagnosis of low back pain
39
29
58
71
20%
0%
40%
Source: NHAMCS 2006
Totals may not add to 100% because of rounding.
33
Men
Women
61
18
60%
20–39
40–64
65+
14
80%
8
2
100%
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
The burden of pain among adults in the United States
Percent of emergency department visits among adults with a diagnosis of low back pain
49
41
48
20%
23
40%
20–39
40–64
65+
10
66
0%
Men
Women
51
60%
8
80%
3
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NHAMCS 2006
Percent of inpatient hospitalizations among adults with a diagnosis of low back pain
38
21
Source: NHDS 2006
34
62
45
20%
0%
Men
Women
40%
20–39
40–64
65+
34
60%
80%
100%
The burden of pain among adults in the United States
Low back pain and analgesic drug use
24% of adults with low back pain report prescription analgesic drug use in the
past month.
18% of adults with low back pain report using a non-prescription analgesic or
certain non-narcotic prescription analgesics nearly every day for a month or longer.
Prevalence of prescription analgesic drug use in the past month among adults with
low back pain in the past 3 months, by gender and age
Age, years
24
Total
21
27
15
20–39
10*
19
29
40–64
27
30
32
30
65+
32
5
0
10
15
20
25
30
35
Percent of adults with low back pain
Total
Men
Women
Source: NHANES 2003–2004; *Estimate is unreliable due to small sample size.
Prevalence of frequent monthly use of nonprescription and select prescription analgesics
among adults with low back pain in the past 3 months, by gender and age
Age, years
18
18
19
Total
8
6*
20–39
9*
19
21
40–64
18
41
41
40
65+
5
0
10
15
20
25
Percent of adults with low back pain
Source: NHANES 2003–2004; *Estimate is unreliable due to small sample size.
Bars with the same values may have different lengths because of rounding.
35
30
35
40
45
Total
Men
Women
The burden of pain among adults in the United States
Neck pain
13% of adults report neck pain in the past 3 months. Neck pain is reported more
often by women than men (15% vs. 11%, respectively) and white, non-Hispanic
adults (14%) than black, non-Hispanic adults (10%) or Hispanic adults (11%).
Prevalence of neck pain in the past 3 months among adults, by gender and age
Age, years
13
Total
11
15
10
20–39
8
12
16
40–64
13
18
14
12
65+
16
5
0
10
15
20
25
Percent of adults
Total
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Prevalence of neck pain in the past 3 months among adults, by race/ethnicity and age
Age, years
14
Total
10
11
12
20–39
6
7
16
40–64
13
16
14
12
65+
17
0
2
4
6
8
10
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
37
12
14
16
18
20
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Neck pain and health status
Adults with neck pain are more than twice as likely to report fair or poor health
than those without neck pain (29% vs. 11%, respectively), nearly 4 times as likely
to report arthritis-attributable activity limitations, nearly 4 times as likely to
report being unable to work, more than twice as likely to report reduced sleep
(<6 hours per day), and 4 times more likely to report psychological distress.
Prevalence of selected health status indicators among adults with or without neck pain
11
Fair/poor health
29
9
Limitation of activity due to
arthritis or joint symptoms
34
5
Unable to work
18
6
<6 hours of sleep
14
2
Psychological distress
8
0
10
Percent of adults
Source: NHIS 2007
38
20
30
40
No neck pain
Neck pain
The burden of pain among adults in the United States
Self-rated fair/poor health is reported by 55% of black, non-Hispanic adults aged
40–64 years and 60% of Hispanic adults aged 65 years and older with neck pain.
Percent of adults with neck pain who report fair/poor health status, by gender and age
Age, years
29
30
Total
10
20–39
17
35
40–64
33
43
65+
39
10
0
20
30
40
50
Percent of adults
Men
Women
Source: NHIS 2007
Percent of adults with neck pain who report fair/poor health status, by race/ethnicity
and age
Age, years
26
Total
48
36
12
20–39
28
14
30
40–64
55
45
37
59
60
65+
0
10
Percent of adults
Source: NHIS 2007
39
20
30
40
50
60
70
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Arthritis-attributable activity limitations are reported by nearly two-thirds of
older black, non-Hispanic and Hispanic adults (64%), and one-half of older
white, non-Hispanic adults (48%) with neck pain.
Percent of adults with neck pain who report activity limitations because of arthritis or
joint symptoms, by gender and age
Age, years
33
Total
36
11
20–39
16
40
40
40–64
46
65+
54
0
10
20
30
40
50
Percent of adults
60
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Percent of adults with neck pain who report activity limitations because of arthritis or
joint symptoms, by race/ethnicity and age
Age, years
34
46
Total
35
15
15
20–39
11
39
56
40–64
44
48
64
64
65+
10
0
20
30
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
40
40
50
60
70
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Reduced daily sleep hours are reported by 1 in 4 black, non-Hispanic adults with
neck pain, 1 in 5 Hispanic adults, and 1 in 8 white, non-Hispanic adults with
neck pain.
Percent of adults with neck pain who report less than 6 usual hours of sleep, by gender
and age
Age, years
14
Total
15
12
20–39
14
17
17
40–64
6
65+
11
0
2
4
6
8
10
12
14
16
Percent of adults
18
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Percent of adults with neck pain who report less than 6 usual hours of sleep, by
race/ethnicity and age
Age, years
13
Total
25
19
12
24
20–39
16
15
27
40–64
21
8
17
65+
15
5
0
10
15
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
41
20
25
30
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Nearly one-quarter of adults aged 40–64 years with neck pain and one-third of
black, non-Hispanic adults with neck pain report being unable to work.
Percent of adults with neck pain who report being unable to work, by gender and age
Age, years
18
Total
18
6
20–39
8
24
40–64
24
0
10
5
15
20
25
30
Percent of adults
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Percent of adults with neck pain who report being unable to work, by race/ethnicity
and age
Age, years
17
33
Total
17
7
15
20–39
5
22
41
40–64
5
0
Percent of adults
Source: NHIS 2007
42
10
15
20
25
25
30
35
40
45
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
More women with neck pain report psychological distress than men (10% vs.
5%, respectively).
More black, non-Hispanic adults (13%) and Hispanic adults (12%) with neck
pain report psychological distress than white, non-Hispanic adults (7%).
Percent of adults with neck pain who report psychological distress, by gender and age
Age, years
5
Total
10
4
20–39
9
7
40–64
12
2
65+
6
0
2
4
6
8
10
12
Percent of adults
Men
Women
Source: NHIS 2007
Percent of adults with neck pain who report psychological distress, by race/ethnicity
and age
Age, years
7
Total
13
12
6
10
20–39
7
8
17
40–64
16
4
5
65+
12
0
2
4
6
8
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
43
10
12
14
16
18
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Neck pain and analgesic drug use
27% of adults with neck pain report prescription analgesic drug use in the past month.
21% of adults with neck pain report using a non-prescription analgesic or certain
non-narcotic prescription analgesics nearly every day for a month or longer.
Prevalence of prescription analgesic drug use in the past month among adults with
neck pain in the past 3 months, by gender and age
Age, years
27
Total
22
31
17
20–39
9*
24
35
33
40–64
36
28
25
65+
30
0
5
10
Percent of adults with neck pain
Source: NHANES 2003–2004
*Estimate is unreliable due to small sample size.
44
15
20
25
30
35
40
Total
Men
Women
The burden of pain among adults in the United States
Prevalence of frequent monthly use of nonprescription and select prescription analgesics
among adults with neck pain in the past 3 months, by gender and age
Age, years
21
Total
19
23
12
9*
20–39
15*
22
22
23
40–64
41
44
65+
38
5
0
10
15
20
25
Percent of adults with neck pain
Source: NHANES 2003–2004
*Estimate is unreliable due to small sample size.
Bars with the same values may have different lengths because of rounding.
45
30
35
40
45
50
Total
Men
Women
The burden of pain among adults in the United States
Severe headaches or migraines
One in 8 adults report severe headaches or migraines in the past 3 months. Women
are more than twice as likely as men to report severe headaches or migraines (17%
vs. 7%, respectively). Older adults are less likely to report severe headaches or
migraines (5%) than adults aged 20–39 (15%) and 40–64 (13%) years.
Prevalence of severe headaches or migraines in the past 3 months among adults, by
gender and age
Age, years
12
Total
7
17
15
20–39
8
22
13
8
40–64
18
5
3
65+
6
10
5
0
15
20
25
Percent of adults
Total
Men
Women
Source: NHIS 2007
Prevalence of severe headaches or migraines in the past 3 months, by race/ethnicity
and age
Age, years
12
Total
12
12
16
20–39
13
10
13
12
40–64
14
4
7
65+
8
0
2
4
6
8
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
47
10
12
14
16
18
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Severe headaches or migraines and health status
Adults with severe headaches or migraines are more than twice as likely to report
fair or poor health than those without headaches or migraines (25% vs. 12%,
respectively), more than 3 times as likely to be unable to work, about 3 times as
likely to report reduced sleep (<6 hours per day), and 5 times as likely to report
psychological distress.
Percent of selected health status indicators among adults with or without severe
headaches or migraines
12
Fair/poor health
25
5
Unable to work
16
6
<6 hours of sleep
16
2
Psychological distress
10
10
0
Percent of adults
Source: NHIS 2007
48
20
30
No headache/migraine
Headache/migraine
The burden of pain among adults in the United States
Self-rated fair or poor health is reported by one-third of adults aged 40–64 years
and 49% of older adults with severe headaches or migraines. 60% of older black,
non-Hispanic adults and 69% of older Hispanic adults with severe headaches or
migraines report fair or poor health status.
Percent of adults with severe headaches or migraines who report fair or poor health
status, by gender and age
Age, years
25
Total
26
8
20–39
17
36
40–64
32
48
65+
49
10
0
20
30
40
50
60
Percent of adults
Men
Women
Source: NHIS 2007
Percent of adults with severe headaches or migraines who report fair or poor health
status, by race/ethnicity and age
Age, years
23
Total
35
32
12
22
20–39
17
30
45
44
40–64
44
60
65+
69
0
10
Percent of adults
Source: NHIS 2007
49
20
30
40
50
60
70
80
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Men aged 65 years and older with severe headaches or migraines are twice as
likely to report reduced daily sleep hours than women aged 65 years and older
(14% vs. 7%, respectively).
Percent of adults with severe headaches or migraines who report less than 6 usual hours
of sleep, by gender and age
Age, years
17
Total
15
16
20–39
12
19
40–64
18
14
65+
7
0
5
10
15
20
25
Percent of adults
Men
Women
Source: NHIS 2007
Percent of adults with severe headaches or migraines who report less than 6 usual hours
of sleep, by race/ethnicity and age
Age, years
15
Total
21
16
14
20–39
18
11
17
40–64
26
22
8
10
65+
14
5
0
Percent of adults
Source: NHIS 2007
50
10
15
20
25
30
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
One in 3 black, non-Hispanic adults aged 40–64 years with severe headaches or
migraines, 1 in 4 Hispanic adults, and 1 in 5 white, non-Hispanic adults report
being unable to work.
Percent of adults with severe headaches or migraines who report being unable to work,
by gender and age
Age, years
18
Total
15
6
20–39
8
27
40–64
21
0
10
5
15
20
25
30
Percent of adults
Men
Women
Source: NHIS 2007
Age, years
Percent of adults with severe headaches or migraines who report being unable to work,
by race/ethnicity and age
15
Total
22
16
8
20–39
10
6
21
40–64
34
26
5
0
Percent of adults
Source: NHIS 2007
51
10
15
20
25
30
35
40
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Older women with severe headaches or migraines are 55% more likely to report
psychological distress (14%) than older men (9%). Nearly one-third of Hispanic
older adults with severe headaches or migraines report psychological distress
compared to 19% of older black, non-Hispanic adults and 9% of older white,
non-Hispanic adults.
Percent of adults with severe headaches or migraines who report psychological distress,
by gender and age
Age, years
11
Total
10
10
20–39
9
12
40–64
11
9
65+
14
0
2
4
6
8
10
12
14
Percent of adults
16
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Percent of adults with severe headaches or migraines who report psychological distress,
by race/ethnicity and age
Age, years
10
Total
13
14
10
20–39
9
7
10
40–64
16
18
9
19
65+
30
5
0
10
15
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
52
20
25
30
35
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Severe headaches or migraines and health care
utilization
In 2006, adults made nearly 11 million physician visits with a headache diagnosis,
over 1 million outpatient hospital visits, 3.3 million emergency department visits,
and 445 thousand inpatient hospitalizations.
The majority of health care visits for headaches were by women and white, nonHispanic adults. Physician office visits and inpatient hospitalizations were mostly
made by adults aged 40–64 years, whereas a larger proportion of outpatient
hospital and emergency department visits were by those aged 20–39 years.
Percent of physician office visits among adults with a diagnosis of headache
26
Men
Women
74
34
54
11
76
20%
0%
40%
20–39
40–64
65+
10
60%
12
3
80%
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NAMCS 2006
Totals may not add to 100% because of rounding.
Percent of outpatient hospital visits among adults with a diagnosis of headache
30
46
44
66
20%
0%
40%
60%
20–39
40–64
65+
10
16
Source: NHAMCS 2006
Totals may not add to 100% because of rounding.
53
Men
Women
70
14
80%
3
100%
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
The burden of pain among adults in the United States
Percent of emergency department visits among adults with a diagnosis of headache
25
51
41
70
20%
0%
Men
Women
75
19
40%
60%
20–39
40–64
65+
8
8
80%
2
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NHAMCS 2006
Totals may not add to 100% because of rounding.
Percent of inpatient hospitalizations among adults with a diagnosis of headache
22
36
20%
0%
50
40%
Source: NHDS 2006
Totals may not add to 100% because of rounding.
54
Men
Women
77
60%
20–39
40–64
65+
14
80%
100%
The burden of pain among adults in the United States
Severe headaches/migraines and analgesic drug use
23% of adults with severe headaches/migraines report prescription analgesic drug
use in the past month.
15% of adults with severe headaches/migraines report using a non-prescription analgesic
or certain non-narcotic prescription analgesics nearly every day for a month or longer.
Prevalence of prescription analgesic drug use in the past month among adults with
severe headaches/migraines in the past 3 months, by gender and age
Age, years
23
Total
21
24
15
20–39
11*
16
30
40–64
29
31
35
28*
65+
38*
5
0
10
15
20
25
30
35
Percent of adults with severe headaches/migraines
40
Total
Men
Women
Source: NHANES 2003–2004; *Estimate is unreliable due to small sample size.
Prevalence of frequent monthly use of nonprescription and select prescription analgesics
among adults with severe headaches/migraines in the past 3 months, by gender and age
Age, years
15
15
15
Total
9
20–39
7*
10*
18
40–64
20
17
35
34*
35
65+
0
5
10
15
20
Percent of adults with severe headaches/migraines
Source: NHANES 2003–2004; *Estimate is unreliable due to small sample size.
Bars with the same values may have different lengths because of rounding.
55
25
30
35
40
Total
Men
Women
The burden of pain among adults in the United States
Dental pain
One in 8 adults experienced dental pain in the past year. Men and women have a
similar prevalence of dental pain regardless of age.
Prevalence of dental pain in the past year among adults, by gender and age
Age, years
12
Total
11
13
13
20–39
12
14
13
12
40–64
13
8
8
65+
9
2
0
4
6
8
10
12
14
16
Percent of adults
Total
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Prevalence of dental pain in the past year among adults, by race/ethnicity and age
Age, years
12
12
Total
10
15
11
20–39
10
13
13
40–64
11
8
10
10
65+
2
0
4
6
8
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
57
10
12
14
16
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Face or jaw pain
4% of adults report facial ache or pain in the jaw muscles or the joint in front
of the ear. Women are three times as likely as men to report this type of pain
(6% vs. 2%, respectively).
Prevalence of face or jaw pain in the past 3 months among adults, by gender and age
Age, years
4
Total
2
6
4
2
20–39
6
5
3
40–64
6
3
1
65+
4
0
2
1
3
4
5
6
Percent of adults
7
Total
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Prevalence of face or jaw pain in the past 3 months among adults, by race/ethnicity
and age
Age, years
4
Total
3
3
5
20–39
2
3
5
40–64
4
4
3
3*
65+
4*
1
0
2
3
Percent of adults
Source: NHIS 2007
*Estimate is unreliable due to small sample size.
Bars with the same values may have different lengths because of rounding.
58
4
5
6
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Adults with face or jaw pain are 2.5 times more likely to report fair or poor
health status than adults with no pain (33% vs. 13%, respectively), nearly 4 times
as likely to be unable to work, more than twice as likely to have reduced sleep
(<6 hours per day), and nearly 7 times as likely to report psychological distress.
Prevalence of selected health status indicators among adults with or without face or
jaw pain
13
Fair/poor health
33
6
Unable to work
22
7
<6 hours of sleep
17
2
Psychological distress
13
0
10
Percent of adults
Source: NHIS 2007
59
20
30
40
No face/jaw pain
Face/jaw pain
The burden of pain among adults in the United States
Pain and selected diseases or
conditions
Arthritis
47.3 million adults have diagnosed arthritis (22%). Arthritic conditions such as
osteoarthritis and rheumatoid arthritis are characterized by joint pain in the
extremities.
The prevalence is higher among women (25%) than men (18%), older age groups
(48%, 65 and older; 25%, 40–64 years) than younger age groups (6%, 20–39
years), and white, non-Hispanic adults (25%) than black, non-Hispanic (19%)
and Hispanic (12%) adults.
Prevalence of arthritis is greater among adults who are obese (30%) or overweight
(21%) than adults who are normal weight (16%).
Prevalence of arthritis among adults, by gender and age
Age, years
22
Total
18
25
6
20–39
5
7
25
21
40–64
28
48
41
65+
52
10
0
Percent of adults
Source: NHIS 2007
61
20
30
40
50
60
Total
Men
Women
The burden of pain among adults in the United States
Prevalence of arthritis among adults, by race/ethnicity and age
Age, years
25
Total
19
12
7
4
20–39
3
27
24
40–64
19
49
52
65+
38
10
0
Percent of adults
Source: NHIS 2007
62
20
30
40
50
60
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Prevalence of arthritis among adults, by body weight and gender
16
21
Total
30
13
17
Men
24
18
26
Women
36
0
10
20
30
40
Normal
Overweight
Obese
Percent of adults
Source: NHIS 2007
Prevalence of arthritis among adults, by body weight and race/ethnicity
18
White,
non-Hispanic
24
35
12
Black,
non-Hispanic
18
26
9
Hispanic
12
15
0
10
20
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
63
30
40
Normal
Overweight
Obese
The burden of pain among adults in the United States
Arthritis and health status
Arthritis is a leading cause of disability and is associated with substantial activity
limitation, work disability and reduced quality of life. Adults with arthritis are
more than 3 times as likely to report fair or poor health than those without
arthritis (31% vs. 9%, respectively), 11 times more likely to report arthritisattributable activity limitations, 5 times more likely to report being unable to
work, nearly twice as likely to report reduced hours of sleep (<6 hours per day),
and 3 times as likely to report psychological distress.
Prevalence of selected health status indicators among adults with or without arthritis
9
Fair/poor health
31
4
Limitation of activity due to
arthritis or joint symptoms
44
4
Unable to work
20
6
<6 hours of sleep
11
2
Psychological distress
6
10
0
20
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
64
30
40
50
No arthritis
Arthritis
The burden of pain among adults in the United States
Self-rated fair or poor health is reported by about 1 in 3 adults with arthritis. The
prevalence generally increases with age regardless of gender or race/ethnicity.
Percent of adults with arthritis who report fair/poor health status, by gender and age
Age, years
30
Total
32
15
20–39
28
29
40–64
32
36
65+
34
10
0
20
30
40
50
Percent of adults
Men
Women
Source: NHIS 2007
Percent of adults with arthritis who report fair/poor health status, by race/ethnicity
and age
Age, years
29
Total
42
45
20
20–39
28
34
28
40–64
44
43
32
43
65+
55
10
0
20
30
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
65
40
50
60
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
42% of men and 46% of women with arthritis report arthritis-related activity
limitations. 52% of black, non-Hispanic adults with arthritis and 48% of
Hispanic adults with arthritis report being limited in their usual daily activities.
Percent of adults with arthritis who report activity limitations because of arthritis or
joint symptoms, by gender and age
Age, years
42
Total
46
31
31
20–39
43
40–64
46
44
65+
50
0
10
20
30
40
50
60
Percent of adults
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Percent of adults with arthritis who report activity limitations because of arthritis or
joint symptoms,, by race/ethnicity and age
Age, years
43
52
Total
48
31
36
20–39
33
44
40–64
54
47
46
54
65+
58
0
10
Percent of adults
Source: NHIS 2007
66
20
30
40
50
60
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
More young adults with arthritis report reduced daily sleep hours (16%) than
adults aged 40–64 years (13%) and adults aged 65 and older (7%) with arthritis.
Percent of adults with arthritis who report less than 6 usual hours of sleep, by gender
and age
Age, years
11
Total
11
15
20–39
17
13
40–64
13
6
65+
8
0
2
4
6
8
10
12
14
16
Percent of adults
18
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Percent of adults with arthritis who report less than 6 usual hours of sleep, by
race/ethnicity and age
Age, years
10
Total
17
18
16
22
20–39
19
11
20
20
40–64
6
12
65+
15
0
5
10
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
67
15
20
25
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
20% of adults with arthritis report being unable to work. Nearly one-third of
black, non-Hispanic adults aged 40–64 years with arthritis report being unable to
work (32%).
Percent of adults with arthritis who report being unable to work, by gender and age
Age, years
19
Total
21
10
20–39
16
20
40–64
22
5
0
10
15
20
25
Percent of adults
Men
Women
Source: NHIS 2007
Percent of adults with arthritis who report being unable to work, by race/ethnicity and age
Age, years
19
19
Total
29
20
20
20
20
29
14 14
14 14
14 14
20–39
40–64
32
32
21
21
5
0
10
15
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
68
20
25
30
35
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
6% of adults with arthritis report psychological distress. Generally, the prevalence
declines with age and is greatest among women (7%) and Hispanic adults (11%).
Percent of adults with arthritis who report psychological distress, by gender and age
Age, years
4
Total
7
6
20–39
9
4
40–64
10
2
65+
3
0
2
4
6
8
10
12
Percent of adults
Men
Women
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
Percent of adults with arthritis who report psychological distress, by race/ethnicity
and age
Age, years
5
Total
6
11
8
4
20–39
14
7
8
40–64
12
2
3
65+
10
2
0
4
6
8
Percent of adults
Source: NHIS 2007
Bars with the same values may have different lengths because of rounding.
69
10
12
14
16
White, non-Hispanic
Black, non-Hispanic
Hispanic
The burden of pain among adults in the United States
Arthritis and analgesic drug use
37% of adults with arthritis report prescription analgesic drug use.
31% of adults with arthritis report using a non-prescription or non-narcotic
prescription analgesic nearly every day for a month or longer.
Prevalence of prescription analgesic drug use in the past month among adults with
arthritis, by gender and age*
Age, years
37
Total
35
38
42
40–64
39
44
34
33
65+
35
5
0
10
15
20
25
30
35
Percent of adults with arthritis
Source: NHANES 2003–2004
*Estimates for 20–39 year age group are unreliable due to small sample size and are not shown.
70
40
45
50
Total
Men
Women
The burden of pain among adults in the United States
Prevalence of current frequent monthly use of nonprescription and select prescription
non-narcotic analgesics among adults with arthritis, by gender and age*
Age, years
31
31
31
Total
28
29
40–64
27
40
41
39
65+
5
0
10
15
20
25
30
Percent of adults with arthritis
Source: NHANES 2003–2004
*Estimates for 20–39 year age group are unreliable due to small sample size and are not shown.
Bars with the same values may have different lengths because of rounding.
71
35
40
45
Total
Men
Women
The burden of pain among adults in the United States
Peripheral neuropathy
14% of adults aged 40 years and older have peripheral neuropathy;
about three fourths are asymptomatic.
Based on monofilament testing, 14% of adults have peripheral neuropathy,
damage to nerves that carry information from the brain and spinal cord to other
parts of the body. It is more than twice as prevalent among adults with diabetes as
adults with no diabetes (28% vs. 11%, respectively).
50% of adults with diabetes who have peripheral neuropathy report having
pain/tingling in their feet or numbness/loss of feeling in the prior 3 months (14%
symptomatic; 14% asymptomatic).
Prevalence of peripheral neuropathy among adults aged 40 years and older by diabetes
status and age
10
Total
Total
4
9
No Diabetes
2
40–64
Diabetes
14
Total
7
No Diabetes
6
65+
Diabetes
14
2
2
10
11
Total
18
No Diabetes
17
Diabetes
7
5
20
0
5
10
15
20
18
25
30
Percent
Source: NHANES 1999-2004; Symptomatic persons reported numbness/loss of feeling or painful sensations/tingling
in feet during the preceding 3 months.
73
35
40
Asymptomatic
Symptomatic
The burden of pain among adults in the United States
Women
Prevalence of peripheral neuropathy among adults aged 40 years and older by diabetes
status and gender
Total
7
No Diabetes
7
3
2
Diabetes
12
Men
Total
11
13
No Diabetes
5
12
3
Diabetes
0
5
17
15
10
17
20
25
30
Percent
35
40
Asymptomatic
Symptomatic
Source: NHANES 1999–2004
Mexican
American
Black,
non-Hispanic
White,
non-Hispanic
Prevalence of peripheral neuropathy among adults aged 40 years and older by diabetes
status and race/ethnicity
10
Total
4
9
No Diabetes
3
Diabetes
14
Total
16
12
No Diabetes
4
11
2
Diabetes
14
Total
10
No Diabetes
9
13
4
2
Diabetes
15
0
5
Percent
Source: NHANES 1999–2004
74
10
15
11
20
25
30
35
40
Asymptomatic
Symptomatic
The burden of pain among adults in the United States
Diabetic neuropathy
Annually, there are 1.4 million physician office visits by adults aged 20 years and
older with a diagnosis of diabetic neuropathy. Diabetic neuropathy is damage to
the peripheral nerves that occurs secondary to vascular problems that occur with
diabetes. Additionally, there are an average of 132 thousand outpatient hospital
visits, 40 thousand emergency department visits, and 392 thousand inpatient
hospitalizations with a diagnosis of diabetic neuropathy.
The majority of ambulatory and inpatient visits for diabetic neuropathy are by
women (46–65%), adults aged 40–64 years (46–57%), and white, non-Hispanic
adults (54–70%).
37% of physician office visits with a primary diagnosis of diabetic neuropathy
have an analgesic drug mention, that is, an analgesic drug was prescribed,
administered, or continued.
Annual number of medical visits by adults aged 20 years and older with a diagnosis of
diabetic neuropathy by type of visit
Physician office
1,359
Outpatient hospital
132
Emergency room
40
Inpatient hospitalization
392
0
200
400
Number of visits, in thousands
Source: 2002–2006: NAMCS, NHAMCS, NHDS
75
600
800
1000
1200
1400
1600
The burden of pain among adults in the United States
Percent of physician office visits among adults with a diagnosis of diabetic neuropathy
50
1*
50
20–39
40–64
65+
49
70
20%
0%
Men
Women
50
20
40%
60%
8*
80%
3*
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NAMCS 2002–2006
*Estimate is unreliable because of small sample size.
Totals may not add to 100% because of rounding.
Percent of outpatient hospital visits among adults with a diagnosis of diabetic neuropathy
54
8*
55
20%
18
40%
Source: NHAMCS 2002–2006
*Estimate is unreliable because of small sample size.
Totals may not add to 100% because of rounding.
76
20–39
40–64
65+
38
67
0%
Men
Women
46
60%
10*
80%
5*
100%
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
The burden of pain among adults in the United States
Percent of emergency department visits among adults with a diagnosis of diabetic
neuropathy
35*
19
57
20%
30
40%
20–39
40–64
65+
24
54
0%
Men
Women
65
60%
15* 1
80%
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NHAMCS 2002–2006
*Estimate is unreliable because of small sample size.
Totals may not add to 100% because of rounding.
Percent of inpatient hospitalizations among adults with a diagnosis of diabetic neuropathy
48
9
0%
Source: NHDS 2002–2006
77
52
46
20%
Men
Women
20–39
40–64
65+
45
40%
60%
80%
100%
The burden of pain among adults in the United States
Fibromyalgia
More than six million adults have fibromyalgia, a disorder characterized by
fatigue, stiffness, joint tenderness, and widespread muscle pain.
Annually, there are 4.5 million physician office visits by adults aged 20 years and
older, 390 thousand outpatient hospital visits, 413 thousand emergency department
visits, and 157 thousand inpatient hospitalizations with a diagnosis of fibromyalgia.
71% of physician office visits with a primary diagnosis of fibromyalgia had an
analgesic drug mention, that is, an analgesic drug was prescribed, administered,
or continued; 29% had an antidepressant mention and 14% had an anxiolytic,
sedative, or hypnotic drug mention.
The majority of visits with a fibromyalgia diagnosis are made by women (76–87%),
adults aged 40–64 years (60–62%), and white, non-Hispanic adults (73–82%).
The exception is emergency department visits which have relatively more men,
adults aged 20–39 years, and black, non-Hispanic adults, when compared with
other types of visits.
Number of medical visits by adults aged 20 years and older with a diagnosis of fibromyalgia
by type of visit
Physician office
4,480
390
Outpatient hospital
413
Emergency room
Inpatient hospitalization
157
1000
0
Number of visits, in thousands
Source: 2002–2006: NAMCS, NHAMCS, NHDS.
79
2000
3000
4000
5000
The burden of pain among adults in the United States
Percent of physician office visits among adults with a diagnosis of fibromyalgia
22
Men
Women
78
19
62
20
82
20%
0%
20–39
40–64
65+
8
40%
60%
7
80%
3*
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NAMCS 2002–2006
*Estimate is unreliable because of small sample size.
Totals may not add to 100% because of rounding.
Percent of outpatient hospital visits among adults with a diagnosis of fibromyalgia
24
26
61
20%
40%
60%
20–39
40–64
65+
13
14
73
0%
Men
Women
76
11
80%
2*
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NHAMCS 2002–2006
*Estimate is unreliable because of small sample size.
Percent of inpatient hospitalizations among adults with a diagnosis of fibromyalgia
13
16
0%
60
20%
40%
Source: NHDS 2002–2006
Totals may not add to 100% because of rounding.
80
Men
Women
87
20–39
40–64
65+
23
60%
80%
100%
The burden of pain among adults in the United States
Percent of emergency department visits among adults with a diagnosis of fibromyalgia
39
42
47
55
40%
60%
20–39
40–64
65+
11
30
20%
0%
Men
Women
61
13
2*
80%
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NHAMCS 2002–2006
*Estimate is unreliable because of small sample size.
Percent of fibromyalgia office visits with a drug mention for analgesics, antidepressants,
or anxiolytics/sedatives/hypnotics
71
Analgesics
63
29*
30
Antidepressants
Anxiolytics, sedatives,
hypnotics
14*
20
20
0
Percent of fibromyalgia-related office visits
Source: NAMCS 2006
*Estmate is unreliable because of small sample size.
81
40
60
80
Primary diagnosis
Any diagnosis
The burden of pain among adults in the United States
Shingles
Annually, there are 1.2 million physician office visits by adults aged 20 years and
older with a diagnosis of shingles, a viral disease characterized by a painful skin
rash. Annually, there are an additional 107 thousand outpatient hospital visits,
157 thousand emergency department visits, and 33 thousand inpatient
hospitalizations with a diagnosis of shingles.
58% of physician office visits with a primary diagnosis of shingles had an
analgesic drug mention, that is, an analgesic drug was prescribed, administered,
or continued.
The majority of visits for shingles are by women (54–65%), adults aged 40–64
years (32–44%), and white, non-Hispanic adults (62–85%). The exception is with
inpatient hospitalizations, where over two-thirds of the hospitalizations with a
shingles diagnosis are by adults aged 65 and older.
Annual number of medical visits by adults aged 20 years and older with a diagnosis of
shingles, by type of visit
Physician office
1,154
Outpatient hospital
107
Emergency room
157
Inpatient hospitalization
33
200
0
400
Number of visits, in thousands
Source: 2002–2006: NAMCS, NHAMCS, NHDS.
83
600
800
1000
1200
1400
The burden of pain among adults in the United States
Percent of physician office visits among adults with a diagnosis of shingles
42
15*
Men
Women
58
32
20–39
40–64
65+
53
84
20%
0%
40%
6*
60%
8*
80%
3*
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NAMCS 2002–2006
*Estimate is unreliable because of small sample size.
Totals may not add to 100% because of rounding.
Percent of outpatient hospital visits among adults with a diagnosis of shingles
37
Men
Women
63
22*
34
85
20%
0%
3*
40%
Source: NHAMCS 2002–2006
*Estimate is unreliable because of small sample size.
84
20–39
40–64
65+
44
60%
80%
9*
3*
100%
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
The burden of pain among adults in the United States
Percent of emergency department visits among adults with a diagnosis of shingles
Men
Women
54
46
26
44
62
20%
0%
20
40%
20–39
40–64
65+
31
60%
13
80%
4*
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
100%
Source: NHAMCS 2002–2006
*Estimate is unreliable because of small sample size.
Totals may not add to 100% because of rounding.
Percent of inpatient hospitalizations among adults with a diagnosis of shingles
35
5
0%
26
20%
Source: NHDS 2002–2006
85
Men
Women
65
20–39
40–64
65+
69
40%
60%
80%
100%
The burden of pain among adults in the United States
Injury
In 2006, there were nearly 34 million physician office visits for a bodily injury,
which includes sprains or strains, fractures, contusions, dislocations, crushes, or
burns. Sprains and strains are the most common type of injury, with nearly 17
million office visits. This was followed by 8 million visits with a fracture diagnosis
and 7 million for a contusion.
14 million or 43% of all injury-related office visits had an analgesic drug mention,
that is, an analgesic drug was prescribed, administered, or continued during the
office visit. 53% of sprain/strain visits had an analgesic drug mention.
Number of physician office visits by adults aged 20 years and older with an injury-related
diagnosis and analgesic drug mention
Any injury*
14
Sprains and strains
9
Fractures
3
Superficial contusion
2
Dislocation
34
17
8
7
1 2
0
5
10
Physician office visits, in millions
Source: NAMCS 2006
*Includes all injuries shown and bodily crushes and burns.
87
15
20
25
30
35
Total # of office visits
Visits with analgesic drug mention
The burden of pain among adults in the United States
Percent of analgesic drug mentions among office visits with any primary injury-related
diagnosis
42
Men
42
Women
20–39
47
40–64
42
65+
34
White,
non-Hispanic
Black,
non-Hispanic
41
31
Hispanic
46
0
5
Percent
Source: NAMCS 2006
88
10
15
20
25
30
35
40
45
50
The burden of pain among adults in the United States
Percent of analgesic drug mentions among office visits with a primary injury-related
diagnosis of strains and sprains
54
Men
51
Women
20–39
55
40–64
53
65+
45*
White,
non-Hispanic
Black,
non-Hispanic
52
36*
Hispanic
55
0
10
20
Percent
Source: NAMCS 2006
*Estimate is unreliable due to small sample size.
89
30
40
50
60
The burden of pain among adults in the United States
Appendix
Data sources
National Health and Nutrition Examination Survey (NHANES), 1999–2004
US Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Health Statistics
The NHANES is a sample survey designed to obtain nationally representative information on
the health and nutrition of the civilian, non-institutionalized population of the United States.
It is conducted by the National Center for Health Statistics (NCHS), a part of the Centers for
Disease Control and Prevention (CDC). Survey participants receive a face-to-face interview in
their homes to obtain information on health history, health behaviors, and risk factors.
Participants subsequently undergo a physical examination in a mobile examination center.
The survey is conducted in 2-year cycles. The 1999–2004 survey is an aggregation of the
three most recent releases of NHANES (1999–2000, 2001–2002, and 2003–2004). The total
population of adults aged 20 years and older sampled during the 2003–2004 cycle is 5041,
including 1494 persons aged 65 and older. The total population of adults aged 40 years and
older sampled during the 1999–2004 cycle is 9970.
National Health Care Surveys:
US Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Health Statistics
National Ambulatory Medical Care Survey (NAMCS), 2002–2006
The NAMCS is a national survey of physicians designed to meet the need for objective,
reliable information about the provision and use of ambulatory medical care services in
the United States. It is conducted by the National Center for Health Statistics (NCHS), a
part of the Centers for Disease Control and Prevention (CDC). Findings are based on a
sample of visits to non-federally employed office-based physicians who are primarily
engaged in direct patient care. Physicians in the specialties of anesthesiology, pathology,
and radiology are excluded from the survey. The survey was conducted annually from
1973 to 1981, in 1985, and annually since 1989. The sample size for adults aged 20
years and older for 2006 is 23,819 visits and for 2002–2006 is 109,041 visits.
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The burden of pain among adults in the United States
National Hospital Ambulatory Medical Care Survey (NHAMCS), 2002–2006
The NHAMCS, begun in 1992, is the longest continuously running nationally representative
survey of visits to the emergency and outpatient departments of noninstitutional general
and short-stay hospitals, exclusive of Federal, military, and Veterans Administration hospitals
in the 50 States and the District of Columbia. An outpatient department is a hospital
facility where nonurgent ambulatory medical care is provided under the supervision of
a physician. The following are examples of the types of clinics included in NHAMCS:
general medicine, surgery, pediatrics, obstetrics and gynecology, substance abuse (excluding
methadone maintenance), and others (e.g., psychiatry and neurology). Clinics excluded
from NHAMCS include ambulatory surgery centers, chemotherapy, employee health
service, renal dialysis, methadone maintenance, and radiology. Data are released as two
separate files, the emergency department data file and the outpatient department data file.
The sample size for emergency department visits for adults aged 20 years and older for
2006 is 25,465 and 2002–2006 is 133,074. The sample size for outpatient department
visits for adults aged 20 years and older for 2006 is 24,630 and 2002–2006 is 121,643.
National Hospital Discharge Survey (NHDS), 2002–2006
The NHDS, which has been conducted annually since 1965, is a national probability
survey of inpatients discharged from non-Federal short-stay hospitals in the United
States. The NHDS collects data from a sample of more than 300,000 inpatient records
acquired from a national sample of about 500 hospitals. Data are available on patient
characteristics including age, race, and sex; administrative information including patient
disposition, expected sources of payment, and source of admission; and medical information
including diagnoses and procedures. Sample size for adults aged 20 and older for 2006 is
301,075 records and for 2002–2006 is 1,398,311 records.
National Health Interview Survey (NHIS), 2007
US Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Health Statistics
The NHIS is a nationally representative interview survey based on a sample of the noninstitutionalized US population. Surveys in the series have been conducted annually since
1957, with the last major restructuring occurring in 1997. The survey consists of personal
interviews in a population-based national sample. The 2007 sample consists of 22,814 adults
aged 20 and older, with 8,285 between the ages of 20 to 39, and 4,583 aged 65 and older.
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The burden of pain among adults in the United States
Definitions
Pain sites
Dental pain: Persons were classified as having dental pain if they responded positively to the
NHIS question, “During the past 12 months, have you had dental pain?”
Face or jaw pain: Persons were classified as having face or jaw pain if they responded positively
to the NHIS question, “During the past 3 months, did you have facial ache or pain in the jaw
muscles or the joint in front of the ear?” Respondents were instructed to report pain that had
lasted a whole day or more, and not to report fleeting or minor aches or pains
Joint pain: Persons were classified as having joint pain if they responded positively to the
NHIS question, “During the past 30 days, have you had any symptoms of pain, aching,
stiffness in or around a joint?’’ Respondents were instructed to report the affected joints
but not to include the back or neck. On the NHANES, the question asked about joint pain
during the past 12 months.
Severe joint pain was defined based on the NHIS 2006 follow-up question, “During the past
30 days, how bad was your joint pain on average?’’ Respondents were instructed to answer
on a scale of 0–10 where 0 was no pain or aching and 10 was pain or aching as bad as it can
be. Severe pain was defined as a response of 7–10.
Low back pain: Persons were classified as having low back pain if they responded positively to
the NHIS or NHANES question, “During the past 3 months, did you have low back pain?”
Respondents were instructed to report pain that had lasted a whole day or more, and not to
report fleeting or minor aches or pains.
Neck pain: Persons were classified as having neck pain if they responded positively to the
NHIS or NHANES question, “During the past 3 months, did you have neck pain?”
Respondents were instructed to report pain that had lasted a whole day or more, and not
to report fleeting or minor aches or pains.
Severe headaches or migraines: Persons were classified as having severe headache or migraine
if they responded positively to the NHIS or NHANES question, “During the past 3 months,
did you have a severe headache or migraine?” Respondents were instructed to report pain
that had lasted a whole day or more, and not to report fleeting or minor aches or pains.
Pain-related diseases and conditions
Arthritis: Persons were classified as having arthritis if they responded positively to the NHIS
question, “Have you ever been told by a doctor or other health professional that you had
some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?” On the
NHANES, the question asked only about arthritis.
Peripheral neuropathy (PN): For the 1999–2000, 2001–2002, and 2003–2004 NHANES surveys,
participants aged 40 years and older received monofilament testing of foot sensation at three
sites (plantar, first metatarsal head; plantar, fifth metatarsal head; and plantar, hallux) on the
bottom of each foot (total of six sites). PN was defined as 1 or more insensate areas.
Symptomatic PN: Persons with PN were classified as symptomatic if they responded positively
to either question, “During the past 3 months, have you had a painful sensation or tingling in
your hands or feet? Exclude normal foot aches from standing or walking for long periods” or
“During the past 3 months, have you had numbness or loss of feeling in your feet, other than
from your feet falling asleep?”
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The burden of pain among adults in the United States
Diagnostic classification used in health care visit charts
Clinical classification codes from the International Classification of Diseases (ICD),
9th Revision, Clinical Modification (ICD-9-CM)
Condition
ICD-9-CM Code
Diabetic neuropathy
Fibromyalgia
Injury
Fracture
Dislocation
Sprains and strains
Contusion/superficial
Crush
Burns
Joint pain
Low back pain
Shingles
Severe headache or migraines
250.6
729.1
800-829
830-839
840-848
910-924
925-929
940-949
719.4
724.2
53.9
346, 784.0, 307.81
Health status indicators
General health status: Persons rated their health in response to the NHIS question, “Would
you say your health in general was excellent, very good, good, fair, or poor?”
Activity limitations: Persons were classified as having activity limitations if they responded
positively to the NHIS question, “Are you now limited in any way in any of your usual
activities because of arthritis or joint symptoms?”
Unable to work: Persons were classified as being unable to work if they responded positively
to the NHIS questions, “Does a physical, mental, or emotional problem NOW keep you from
working at a job or business?”
Psychological distress: Psychological distress was ascertained on the NHIS with the K6
instrument which asked persons to report, “During the past 30 days, how often did you
feel…so sad that nothing could cheer you up? Nervous? Restless or fidgety? Hopeless? That
everything was an effort? And worthless?” Possible answers are: all of the time (4 points),
most of the time (3 points), some of the time (2 points), a little of the time (1 point), and
none of the time (0 points) for a possible total of 0 to 24 points. 13 or more is used to define
serious psychological distress.
Reduced sleep: Persons were classified as having reduced daily sleep if they reported sleeping
less than 6 hours in answer to the NHIS question, “On average, how many hours of sleep do
you get in a 24-hour period?”
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The burden of pain among adults in the United States
Other definitions
Diabetes: Persons were classified as having diabetes if they self-reported in the NHANES
interview having been told by a physician that they have diabetes.
Body mass index (BMI): BMI was calculated as weight in kilograms divided by the square of
height in meters, based on the NHIS sample adult’s responses to survey questions regarding
height and weight.
• Normal weight: A person was classified as normal weight if his/her BMI was greater than
or equal to 18.5 and less than 25.0.
• Overweight: A person was classified as overweight if his/her BMI was greater than or equal
to 25.0 and less than 30.0.
• Obese: A person was classified as obese if his/her BMI was greater than or equal to 30.0.
Drug data
Prescription drug use data: NHANES participants were asked if they had taken a prescription
drug in the past month. Those who answered “yes” were asked to show the interviewer the
medication containers of all prescription drugs. For each drug reported, the interviewer
recorded the product’s complete name from the container. Prescription drugs were classified
based on the therapeutic classification scheme of Cerner Multum’s Lexicon. Analgesic drugs
were identified with a code of 58.
Non-prescription and select non-narcotic prescription analgesic use: NHANES participants were
shown a hand card with a list of non-prescription and prescription non-narcotic analgesics
and asked, “Have you ever taken any of these prescription or over-the-counter pain reliever
medications nearly every day for as long as a month?” If a participant answered affirmatively,
they were asked to identify each product taken and whether they were currently taking the
product daily or nearly every day. Frequent monthly analgesic users were defined as adults
who currently used a pain reliever from the hand card daily or nearly every day.
Drug mentions at office-based physician visits: For the NAMCS, physicians or their staffs were
instructed to record all new or continued medications ordered, supplied, or administered
at the visit. This included prescription and nonprescription preparations, immunizations,
desensitizing agents, and anesthetics. In this survey, recorded medications are referred to as
drug mentions. Visits with one or more drug mentions are termed “drug visits.” Drugs for
the 2006 survey are classified based on the therapeutic classification scheme of Cerner
Multum’s Lexicon: analgesic drugs = 58, antidepressants = 249, and anxiolytics, hypnotics,
and sedatives = 67.
95
P F I Z E R
F A C T S
The Burden of Pain
Among Adults
in the United States
Findings from the National Health and Nutrition Examination Survey,
the National Health Care Surveys, and the National Health Interview Survey
Medical Division
PG283568
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