- Researchers say people in the United States without a college degree report more chronic pain than people who are college graduates.
- They say lower education many times is linked to socioeconomic stressors that can lead to chronic pain.
- They add that many people with lower education levels don’t have adequate healthcare services.
Middle-aged Americans without a 4-year college degree are reporting more pain than older adults.
A new study has revealed that lower educated people in the United States are experiencing an intergenerational increase in pain, with each age group experiencing more pain than generations before them.
The same pattern wasn’t seen for people with a bachelor’s degree.
“In America today, the elderly report less pain than those in midlife. This is the mystery of American pain,” the study authors wrote.
“The gap in pain between the more and less educated has widened in each successive birth cohort,” they added. “The increase seen across birth cohorts cannot be explained by changes in occupation or levels of obesity for the less educated, but fits a more general pattern seen in the ongoing erosion of working-class life for those born after 1950.”
The study by the numbers
In undertaking the study, the researchers used survey responses from more than 2.5 million people to compare the link between age and physical pain.
In the first analysis of the data, the researchers found that people of all races and genders worldwide reported more pain as they got older.
In a subsequent analysis, the researchers accounted for education level and found the same result for Americans with a bachelor’s degree.
For the two-thirds of the U.S. population without a college degree, however, more pain was reported in midlife.
“The rising prevalence of pain is part of the deterioration of the social and economic conditions faced by less-educated Americans,” the authors wrote.
“This seems to be an exclusively American phenomenon, as people in other rich countries do not report higher pain in midlife,” Anne Case, PhD, co-author of the study and a professor of economics and public affairs at the Princeton School of Public and International Affairs in New Jersey, said in a press release.
Why education is a factor
Experts say the impact of lower education on an individual’s health can be significant.
“We know that psychosocial and environmental stressors are important risk factors for pain onset and persistence, and lower education is associated with significant increases in exposures to such stressors, including economic stress and occupational stress, among others,” Roger Fillingim, PhD, director of the University of Florida Pain Research and Intervention Center of Excellence, told Healthline.
“We know that such persistent stressors take a toll on the biological and psychosocial functioning of individuals, which can render them more vulnerable to the experience of pain,” he added.
“Also, lower education often limits access to quality healthcare, which can lead to poorly managed pain. More advanced education often provides protection against these types of stressors and restrictions on healthcare access.”
How pain affects the entire family
Dr. Talal W. Khan, the chair of anesthesiology, pain, and perioperative services at the University of Kansas Health System, says pain in middle age can have a ripple effect through the entire family and cause the cycle to continue.
“It is concerning that some our most vulnerable people suffer pain at an earlier point in their lives,” Khan told Healthline. “Often these people may be living paycheck to paycheck and are possibly the families’ only breadwinner. For them to be debilitated by pain not only affects their own health, but the well-being of their entire family.”
Khan continued, “This leads to a significant portion of the population no longer able to engage in employment to provide for their families and in addition may become dependent on various welfare programs. This becomes a vicious cycle, which could drag the entire family down.”
The researchers say this rise in pain from generation to generation suggests a chronic intergenerational distress for those without a degree.
Dr. Beth Darnall, a pain management specialist at Stanford University Medical Center in California, says the study underscores the health disparities in the United States.
“What we’re really seeing is the latent expression of socioeconomic status, which is very strongly driven by level of education and particularly emerges in the middle ages of life,” Darnall told Healthline.
“People with lower socioeconomic status have poorer health insurance. They have poorer access to healthcare. They work in poorer conditions. They’re forced to prioritize survival over wellness. They have less money to direct to quality food,” she explained.
“We see that heightened stressors associated with lower socioeconomic status correlated with incidence and severity of different diseases and disease processes.”
How to prevent pain
Experts say there are many things people can do to try and prevent pain from developing either in middle age or later in life.
Basic recommendations for a healthy lifestyle such as engaging in regular physical activity, eating nutritional food, getting adequate sleep, maintaining a healthy weight, and managing stress can all act as pain prevention strategies.
In addition, if pain occurs, seeking timely treatment early is important.
Although many of these basic self-care principles can be done at little or no cost, Darnall says it’s not that simple for those of lower socioeconomic status.
“There are things, of course, that people can do at low cost to self-manage their pain, it’s just that people with lower socioeconomic status have less time and less resources,” she explained.
“Pain is deprioritized in their life because they’re more likely to be focused on survival issues, such as paying the rent. So they’re going to be focused on showing up for their shift rather than trying to convince their boss that they should be able to take the day off to attend some medical appointments.”
What this means down the road
The researchers say that as less educated Americans continue to experience more distress across generations, the older adults of tomorrow will experience even more pain than the older adults of today.
Experts say this is problematic for a dysfunctional healthcare system that already struggles to adequately manage and treat pain in Americans.
“The U.S. health system is ill-equipped to cope with this trend,” Dr. Fillingim said. “Our system is built on doing procedures rather than managing long-term health conditions. Many of the lower cost interventions that are effective against pain — such as exercise, psychological interventions, complementary treatments, and self-management — are not covered by many health plans and are thus difficult for patients to access.”
He added, “This is a major public health issue. As a society, we have not prioritized pain management and we are now paying the price.”
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