By Pat Anson, PNN Editor

A provocative new study is warning that middle-aged Americans are experiencing more acute and chronic pain than the elderly, a dramatic shift in pain demographics that is putting further strain on the U.S. healthcare system.

Researchers at Princeton University and the University of Southern California (USC) analyzed survey responses from more than 2.5 million people in the U.S. and European Union. They found a unique pattern in the United States: Physical pain is rising in working class and less-educated Americans under the age of 60.

The findings run counter to long held assumptions that the elderly are more likely to feel pain due to arthritis and other chronic illnesses associated with old age.

“This is the mystery of American pain. Using multiple datasets and definitions of pain, we show today’s midlife Americans have had more pain throughout adulthood than did today’s elderly,” researchers reported in the Proceedings of the National Academy of Sciences (PNAS). “If these patterns continue, pain prevalence will continue to increase for adults; importantly, tomorrow’s elderly will be sicker than today’s elderly, with potentially serious implications for healthcare.”

Researchers Anne Case, PhD, and Sir Angus Deaton of Princeton University and Arthur Stone, PhD, a psychology professor at USC, have studied morbidity and mortality rates around the world. It was the husband-and-wife team of Case and Deaton who first reported on the so-called “deaths of despair” in 2015, an unusual spike in deaths of nearly half a million middle-aged, mostly white Americans.

To build on that groundbreaking research, Case, Deaton and Stone looked at different generations born between 1930-90. They found that men and women of all races usually reported more pain as they aged. But that finding did not hold true for less educated Americans who do not have a college bachelor’s degree – about two-thirds of the adult U.S. population.

"Our expectation was that pain would increase as one's age increases, due to physical deterioration and higher probability of chronic illnesses," said Stone. "But our research found middle-aged Americans had higher levels of pain than the elderly, which is especially pronounced for people without a college degree, and the question was, why?"

Researchers say their findings have major policy implications. As less educated, middle-aged Americans become elderly, they are likely to experience more pain, adding further strain on pain management practices and the healthcare system in general.

Many patients already feel their pain care is inadequate, due to lack of access to opioid pain medication and alternative treatments that are either ineffective or not covered by insurance.

Researchers believe the rise in pain in the working class was caused by the deterioration of their social and economic conditions. Less-educated Americans born after 1950 are more likely to experience social isolation, more fragile home lives, less marriage and more divorce, as well as stagnant wages and job loss. This “epidemic of despair” has barely touched more-educated Americans.

Another explanation for the increase in pain is that people could be more likely to report minor pain than in the past. The growing number of Americans who are obese could also be contributing to the problem, because more weight increases the risk of health problems like arthritis, diabetes and cardiovascular disease.

Whatever the cause, researchers say their findings should signal to policymakers that less-educated Americans are experiencing more distress, and that tomorrow's elderly will feel more pain than today's elderly.

"Pain undermines quality of life, and pain is getting worse for less-educated Americans," Deaton said. "This not only makes their lives worse, but will pose long-term problems for a dysfunctional healthcare system that is not good at treating pain."