Chronic Pain Prevalence after the COVID-19 Pandemic: Troubling Findings

A new US population-based analysis shows significant increases in the prevalence of chronic pain, and of high-impact chronic pain, in the wake of the pandemic. The upsurges were apparent for almost all pain sites considered in the study, including for head/migraine pain.

Considering the wide-ranging health effects of COVID-19, pain researchers have been apprehensive that the pandemic could influence the prevalence of chronic pain, which already affects more people than cancer, heart disease, and diabetes combined. It’s a concern for the migraine field, too, considering the high prevalence and burden of headache disorders, with more than 40 million Americans currently living with them. Yet there are few analyses of how pain prevalence may have changed from before the pandemic through to post-pandemic times.

But now, researchers from the University of Western Ontario, Canada; the University at Buffalo, SUNY, US; and the National Center for Complementary and Integrative Health, NIH, Bethesda, US, have published the most comprehensive analysis of pain prevalence before (the year 2019), during (2021), and after (2023) the pandemic.

The investigators, led by Anna Zajacova, discovered that the prevalence of chronic pain increased from 20.5% in 2019 to 24.3% in 2023 – an overall 18% increase. The prevalence of high-impact chronic pain, defined as pain that frequently limits life or work activities, increased by 13%.

These increases occurred for all population subgroups, and for almost all pain sites, considered in the study, including for head/migraine pain.

Roger Fillingim, a pain researcher at the University of Florida, Gainesville, US, who was not involved with the work, called the study “very interesting” and “a valuable bellwether for chronic pain.”

“The first part of the story is that chronic pain continues to increase in its prevalence, and that’s very concerning,” he said. “But the second part of the story is that these increases in prevalence are fairly well distributed across all population groups. It seemed as if the main group showing the most disproportionate increase were people who had the lowest prevalence to start with. Why this might be raises a lot of questions that are well worth looking at in the future.”

The study appeared online ahead of print on August 5, 2025, in the journal Pain.

Asking a basic question
Zajacova said she had read several editorials suggesting that chronic pain might increase because of COVID-19, yet there wasn’t much data to say one way or the other. As she and her colleagues had published an analysis examining trends in chronic pain a few years earlier, she was curious to see how those trends might have changed in the wake of the pandemic.

“We not only wanted to understand what had been happening with prevalence in more recent years, but we also wanted to see if COVID-19 did have the anticipated effect,” she said. “So, in a way, we looked at this data and asked a very basic question: Did the prevalence of chronic pain increase?”

She and her co-authors relied on data from the National Health Interview Survey (NHIS), an annual cross-sectional survey of thousands of adults who are interviewed about their health. NHIS also gathers comprehensive data on demographics, socioeconomic status, and other important variables. Questions about chronic pain and high-impact chronic pain, including site-specific pain, are only asked every other year, so Zajacova’s team looked at the data from 2019, 2021, and 2023, corresponding to before, during, and after the pandemic, respectively. When combined, these three “waves” of NHIS would include data from more than 90,000 survey respondents.

To begin, the researchers looked at the overall prevalence of chronic pain, high-impact chronic pain, and site-specific pain from 2019 to 2021. They found a chronic pain prevalence of 20.5% in 2019, with a minimal increase to 20.9% in 2021. But, in 2023, there was an 18% increase across the entire study period, with 24.3% reporting chronic pain. That equated to an additional 10 million Americans with chronic pain, bringing the total of American adults living with chronic pain to more than 60 million in 2023 – an astounding figure.

For high-impact chronic pain, prevalence decreased from 2019 to 2021 (from 7.5% to 6.9%). But, like chronic pain prevalence, it rose in 2023, to 8.5%, which was an estimated 13% overall increase. This new information means that more than 21 million Americans lived with high-impact chronic pain in 2023, another startling number.

Zajacova said some of the findings surprised her.

“I actually thought chronic pain would go up during the pandemic,” she said. “There was a lot of discussion about how the pandemic was detrimental to people living with different disabilities. Anecdotally, some people said they felt better during the pandemic. They could work from home, they received stimulus checks to help with the bills, and they could rest when needed. But other people said the opposite: Staying home was very stressful, they couldn’t find childcare, and they thought it was impossible. We wish we could have divided the survey respondents into people who benefitted from being at home and those who did not, but there was no way to do that with the data that had already been collected.”

Fillingim said he, too, was surprised that the increases didn’t occur until the pandemic was over.

“The authors make the case that, during COVID, people may have had relief from sources of stress or exposure that could have been protective. Some people didn’t have to work or could work from home. They no longer had to commute. They could rest when they needed to,” he said. “But, that said, we know essential workers were a group who were excluded from these benefits. And they were likely at greater risk for chronic pain because of the types of work that they do. So, there are definitely interesting nuances in the data that are important to explore.”

An equal opportunity increase – including for migraine
The researchers also looked at pain prevalence for the six pain sites NHIS asks about: Back/neck pain, shoulder/arm pain, hip/knee/leg pain, head/migraine pain, abdominal pain, and tooth/jaw pain. There were significant increases in pain prevalence for all sites except for tooth/jaw pain.

“During the pandemic, getting any kind of healthcare was problematic,” said Zajacova. “Yet, I would have expected an increase in tooth or jaw pain because I might have expected that people would have stopped getting dental care during that time.”

Regarding head/migraine pain specifically, prevalence fell from 4.8% in 2019 to 4.3% in 2021, and then rose to 5.6% in 2023.

The study authors also performed analyses according to survey respondents’ sex, age, socioeconomic status, race/ethnicity, educational attainment, and whether they were rural/urban dwellers. The increases in chronic pain and high-impact chronic pain prevalence from 2019 to 2023 occurred in all of these population subgroups. As Fillingim put it, the increases in prevalence were “an equal opportunity phenomenon.”

“Men and women seemed to be equally impacted, and it was the same across racial and ethnic groups,” he said. “All the factors that could be driving increases happened in all these different groups, which is very interesting and not often the case with things that influence chronic pain.”

The effects of long COVID
In a final analysis, Zajacova and colleagues looked at factors that might explain the increases in prevalence, including how much of the increases could be attributed to long COVID, a condition where people experience persistent symptoms, including pain, or new health problems, after COVID-19 infection. She said creating a statistical model to investigate the contribution of long COVID was “tricky,” since NHIS relies on self-reported long COVID experiences, and because there was no long COVID in 2019 to allow a comparison to 2021 and 2023.

“We did alternative models where we split the people who had long COVID versus those who didn’t so we could ask, How did the prevalence increase in those two groups? That allows you to estimate how much long COVID might explain,” she said.

But long COVID could explain only about 13% of the increase in chronic pain and high-impact chronic pain prevalence from 2019 to 2023. This, said Zajacova, was yet another surprise.

“Long COVID was not the driving force of the increase in chronic pain,” she said. “Even though pain is one of the symptoms of this condition, it couldn’t explain the whole difference between 2019 and 2023,” she said. “It means there is not just one explanation that can account for these changes in pain. There is something, or maybe many things, that created conditions across these years that increased pain,” she added.

Future steps
With so many unanswered questions, Zajacova would like to look at the data from the 2025 wave of the NHIS and see if the increases in pain prevalence will continue. She added that she and her colleagues are also interested in examining data from the University of Michigan Health and Retirement Study, a longitudinal survey of approximately 20,000 adults in America over 50, to see if similar patterns emerge.

Fillingim, for his part, would like to see more of these population-level studies, especially as concerns grow about the funding of biomedical and population health research as a result of new US administration policies (see MSC related news). He also said the new results raise questions for future research that could help improve treatment for migraine and chronic pain conditions.

“One of the most important things about this study is that it shows us just how important it is to keep collecting this kind of population-level data so we can see what trends are emerging,” he said. “Researchers could, based on these results, conduct some smaller-scale mechanistic studies to look at people with migraine who had COVID or long COVID to see if there’s evidence of different mechanisms at play. Does the migraine profile look the same, or does it change over time? This may require us to develop different treatments.”

In the meantime, Zajacova hopes the new results show that “something bigger is going on” that requires further study.

“Millions of people live with chronic pain,” she said. “And while it is easy to say that is because of an injury or some medical condition, there are broader trends, broader factors, that can play a role, and we should be paying attention to them.”

Kayt Sukel is a freelance writer based outside of Houston, Texas.

Image credit: 123RF Stock Photo.

Reference
Pain among US adults before, during, and after the COVID-19 pandemic: a study using the 2019 to 2023 National Health Interview Survey.
Zajacova et al.
Pain. 2025 Aug 5:10.1097/j.pain.0000000000003764. Online ahead of print.