How many people, and how fast

Two different questions matter here and they are constantly conflated. Prevalence asks how many people have chronic pain right now. Incidence asks how quickly new people join them. Policy tends to be written against prevalence and surprised by incidence.

On prevalence: analyzing the 2016 National Health Interview Survey, CDC researchers estimated that 20.4% of US adults — about 50.0 million people — had chronic pain, and that 8.0%, about 19.6 million, had high-impact chronic pain, meaning pain that frequently limited life or work activities. Prevalence was higher among women, older adults, adults no longer employed, adults living in poverty, adults with public health insurance, and rural residents.

On incidence: a 2023 cohort study using the 2019–2020 NHIS Longitudinal Cohort followed 10,415 adults for a mean of 1.3 years. Among adults who were pain free in 2019, the age-standardized incidence of chronic pain in 2020 was 52.4 cases per 1,000 person-years (95% CI 44.9–59.9), and the incidence of high-impact chronic pain was 12.0 per 1,000 person-years (95% CI 8.2–15.8).

The comparison that makes the point

The authors of that study set their figure against the known incidence of other chronic conditions in US adults. This is their comparison, not ours.

Condition	New cases per 1,000 person-years (US adults)
Chronic pain	52.4
High blood pressure	45.3
Depression	15.9
High-impact chronic pain	12.0
Diabetes	7.1

Chronic pain also persists. Among adults who had chronic pain in 2019, the rate of chronic pain in 2020 was 462.0 per 1,000 person-years, and 61.4% still reported chronic pain a year later. It is not usually a passing state — though it is not permanent either, since 10.4% of adults with chronic pain in 2019 were pain free in 2020.

A note on a figure you may have seen from us. Earlier IntellaRx material cited an incidence of “60 in 1,000” for chronic pain and “10 in 1,000” for high-impact chronic pain. Those are not the published values — 60 is the upper bound of the confidence interval, not the estimate. The correct figures are 52.4 and 12.0 per 1,000 person-years, and they are what this site uses.

Why this is the first step

Because it sets the denominator. A policy instrument that reduces prescribing by a fixed percentage is acting on a population this size, most of whom are not misusing anything. If the instrument has a false-positive rate — and every count-based instrument does — the absolute number of people harmed scales with this denominator. That arithmetic is what step six is about.

It also sets the trajectory. Incidence at this level means the population needing pain care grows every year whether or not the system is ready for it. A response designed only to shrink supply, with nothing built on the demand side, is by construction a response that falls further behind each year.

Questions this raises

What is the difference between chronic pain and high-impact chronic pain?

In these surveys, chronic pain means pain on most days or every day in the past three months. High-impact chronic pain is chronic pain that limits life or work activities on most days or every day. The second is a subset of the first, and it is the group whose lives are substantially restricted. See how to read a prevalence figure.

Does a high incidence of chronic pain mean more people need opioids?

No, and nothing on this site argues that. Incidence sets the size of the population needing pain care of some kind — most of which is not opioid therapy. The point of the figure is that the population is large enough that a blunt instrument applied to it produces a large absolute number of harms. Our note on prescribing limits works through that arithmetic.