Middle-aged Americans are living with more physical pain than older adults are — and the problem is concentrated among the less-educated, a new study finds.
The pattern may seem counterintuitive, since older age generally means more chronic health conditions and wear-and-tear on the body. And the middle-age pain peak is not seen in other wealthy countries, researchers said.
But as in other areas of health, there seems to be a dividing line among Americans, the study found. It's relatively less-educated people who are reporting more pain in middle age — and it's because they are suffering more pain throughout life than older generations did.
"We're not sure why that is," said study author Anne Case, a professor of economics and public affairs emeritus at Princeton University.
But she said her team suspects the causes may be related to a host of social factors affecting younger generations of Americans who lack a college degree: falling wages, job instability, fewer social connections, less marriage, and more divorce.
"It's an unfortunate mix of things," Case said. "And one of the manifestations is pain."
That's not to say, she stressed, that the pain isn't "real" — but that daily stress and poor mental well-being can worsen the experience of physical pain.
And if people are working two jobs, or worried about paying rent, Case said, it's hard to exercise or take other steps to manage pain.
The study was published Sept. 21 in the Proceedings of the National Academy of Sciences. It analyzed responses to several U.S. and international health surveys. The U.S. surveys included Gallup polls done between 2008 and 2017, and the National Health Interview Survey for the years 1997 to 2018.
They asked about pain in different ways. The Gallup polls asked whether people experienced pain for "a lot" of the previous day. The NHIS asked about pain over the past three months.
But both showed the same pattern, Case said. People reported the most pain in middle age, with a decline starting around age 60.
When the researchers looked again, taking education into consideration, things diverged. The middle-age pain peak was only among Americans without a bachelor's degree. Among those with a degree, fewer people reported pain at any age — and pain became more common with advancing age.
Americans with a college degree looked more like Europeans, whose pain reports also increased with age.
But why would older Americans without a college degree have less pain than their younger counterparts? According to Case, each generation of less-educated Americans seems to experience more pain — throughout life — than the ones before.
For example, the researchers found, 32% of less-educated Americans born in 1955 reported pain at age 52. Among people born in 1965, 40% reported pain at 52.
Rising rates of obesity appeared to explain part of that trend, Case said. But she believes social and economic factors play a key role as they have in "deaths of despair," she noted. Those deaths — from suicide, drug overdoses, and alcohol abuse — have been rising among less-educated Americans.
It's unclear exactly how the opioid crisis fits in, Case said. But pain among less-educated Americans may be both a cause and consequence of the epidemic, she noted. Rising rates of pain may have helped fuel more prescriptions, while prolonged opioid use can actually worsen pain.
Dr. David Dickerson is vice chair of the American Society of Anesthesiologists' committee on pain medicine.
He reviewed the study and took issue with the nonspecific ways the surveys, particularly the vague Gallup question, assessed pain. But Dickerson agreed the findings could reflect the widening inequality in the United States — a "health-wealth gap" studies have charted in various health outcomes.
Obesity and its related health problems could be partly driving pain among younger, less-educated Americans, Dickerson said.
But he also stressed that pain cannot be separated into "physical" and "psychological." And the day-to-day stress and insecurity many lower-income Americans face can feed pain, just as physical conditions can, added Dickerson.
He said the new findings underscore a reality that has already been on the radar: Pain is a growing problem among Americans, and that does not bode well for the future.
Dickerson said there is also concern the pandemic will worsen the situation. Many people are not only dealing with greater stress, but more difficulty in dealing with it — whether from less access to health care, fewer ways to exercise, or fewer "feel-good moments" in the day.