NCHS Data Brief ■ No. 390 ■ November 2020

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Chronic Pain and High-impact Chronic Pain Among 

U.S. Adults, 2019

Carla E. Zelaya, Ph.D., James M. Dahlhamer, Ph.D., Jacqueline W. Lucas, M.P.H., and Eric M. Connor, B.S.

Key findings

Data from the National 

Health Interview Survey

● In 2019, 20.4% of adults 

had chronic pain and 7.4% of 

adults had chronic pain that 

frequently limited life or work 

activities (referred to as highimpact chronic pain) in the past 

3 months. 

● Chronic pain and highimpact chronic pain both 

increased with age and were 

highest among adults aged 

65 and over.

● Non-Hispanic white adults 

(23.6%) were more likely to 

have chronic pain compared 

with non-Hispanic black 

(19.3%), Hispanic (13.0%), 

and non-Hispanic Asian 

(6.8%) adults.

● The percentage of adults 

with chronic pain and highimpact chronic pain increased 

as place of residence became 

more rural.

Chronic pain (1) and chronic pain that frequently limits life or work activities, 

referred to in this report as high-impact chronic pain (2), are among the 

most common reasons adults seek medical care (3) and are associated with 

decreased quality of life, opioid dependence, and poor mental health (1,4,5). 

This report examines chronic pain and high-impact chronic pain in the past 

3 months among U.S. adults aged 18 and over by selected demographic 

characteristics and urbanization level.

The percentage of adults who had chronic pain and highimpact chronic pain in the past 3 months was higher for 

women than for men.

● Overall, the prevalence of chronic pain was 20.4%, and the prevalence of 

high-impact chronic pain was 7.4% (Figure 1). 

7.4 6.3

18.5

Figure 1. Percentage of adults aged 18 and over with chronic pain and high-impact chronic pain in 

the past 3 months, overall and by sex: United States, 2019

1Significantly different from men (p < 0.05).

NOTES: Chronic pain is based on responses of “most days” or “every day” to the survey question, “In the past 3 months, how often 

did you have pain? Would you say never, some days, most days, or every day?” High-impact chronic pain is defined as adults who 

have chronic pain and who responded “most days” or “every day” to the survey question, “Over the past 3 months, how often did 

your pain limit your life or work activities? Would you say never, some days, most days, or every day?” Estimates are based on 

household interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 1 at: 

https://www.cdc.gov/nchs/data/databriefs/db390-tables-508.pdf#1.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019. Percent

0

5

10

15

20

25

Chronic pain High-impact chronic pain

Overall Men Women

20.4

19.0

121.7

NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.
NCHS Data Brief ■ No. 390 ■ November 2020

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● Women were more likely to have chronic pain (21.7%) and high-impact chronic pain (8.5%) 

compared with men (19.0% and 6.3%, respectively). 

The percentage of adults who had chronic pain and high-impact chronic 

pain in the past 3 months varied by age group.

● The percentage of adults who had chronic pain in the past 3 months increased with age and 

was higher among those aged 45–64 (25.8%) and 65 and over (30.8%) compared with those 

aged 18–29 (8.5%) and 30–44 (14.6%) (Figure 2). 

● Similarly, the percentage of adults who had high-impact chronic pain in the past 3 months 

increased with age and was also higher among those aged 45–64 (10.3%) and 65 and over 

(11.8%) compared with those aged 18–29 (2.2%) and 30–44 (4.4%).

Figure 2. Percentage of adults aged 18 and over with chronic pain and high-impact chronic pain in the past 3 months, by 

age group: United States, 2019 Percent

1Significant quadratic trend by age group (p < 0.05).

NOTES: Chronic pain is based on responses of “most days” or “every day” to the survey question, “In the past 3 months, how often did you have pain? Would you 

say never, some days, most days, or every day?” High-impact chronic pain is defined as adults who have chronic pain and who responded “most days” or “every 

day” to the survey question, “Over the past 3 months, how often did your pain limit your life or work activities? Would you say never, some days, most days, or 

every day?” Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 2 at: 

https://www.cdc.gov/nchs/data/databriefs/db390-tables-508.pdf#2.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.

30–44 45–64 65 and over

High-impact chronic pain Chronic pain1 1

0

5

10

15

20

25

30

35

8.5

14.6

25.8

30.8

2.2

4.4

10.3

11.8

18–29
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The percentage of adults who had chronic pain and high-impact chronic 

pain in the past 3 months varied by race and Hispanic origin. 

● Non-Hispanic white adults (23.6%) were more likely to have chronic pain in the past 3 

months compared with non-Hispanic black (19.3%), Hispanic (13.0%), and non-Hispanic 

Asian (6.8%) adults. Chronic pain was least likely among non-Hispanic Asian adults 

(Figure 3). 

● Non-Hispanic white adults (8.4%) were more likely to have high-impact chronic pain 

compared with Hispanic (5.3%) and non-Hispanic Asian (2.2%) adults. The observed 

difference in high-impact chronic pain between non-Hispanic white and non-Hispanic black 

adults was not significant. 

● Non-Hispanic Asian adults were least likely to have high-impact chronic pain compared 

with adults of other race and Hispanic-origin groups.

● Non-Hispanic black adults were more likely to have chronic pain and high-impact chronic 

pain (19.3% and 7.4%, respectively) compared with Hispanic adults.

1,313.0

16.8

1,2,319.3

23.6

8.4

2,37.4

1,35.3

12.2

Figure 3. Percentage of adults aged 18 and over with chronic pain and high-impact chronic pain in the past 3 months, by 

race and Hispanic origin: United States, 2019 Percent

1Significantly different from non-Hispanic white adults (p < 0.05). 2Significantly different from Hispanic adults (p < 0.05). 3Significantly different from non-Hispanic Asian adults (p < 0.05).

NOTES: Chronic pain is based on responses of “most days” or “every day” to the survey question, “In the past 3 months, how often did you have pain? Would you 

say never, some days, most days, or every day?” High-impact chronic pain is defined as adults who have chronic pain and who responded “most days” or “every 

day” to the survey question, “Over the past 3 months, how often did your pain limit your life or work activities? Would you say never, some days, most days, or 

every day?” Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 3 at: 

https://www.cdc.gov/nchs/data/databriefs/db390-tables-508.pdf#3.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.

Non-Hispanic white Non-Hispanic black Hispanic Non-Hispanic Asian

Chronic pain High-impact chronic pain

0

5

10

15

20

25
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The percentage of adults who had chronic pain and high-impact chronic 

pain in the past 3 months varied by urbanization level. 

● The percentage of adults who had chronic pain in the past 3 months increased as place of 

residence became more rural, from 16.4% in large central metropolitan areas to 28.1% in 

rural areas (Figure 4).

● The percentage of adults who had high-impact chronic pain in the past 3 months also 

increased as place of residence became more rural, from 6.1% in large central metropolitan 

areas to 10.9% in rural areas.

Figure 4. Percentage of adults aged 18 and over with chronic pain and high-impact chronic pain in the past 3 months, by 

urbanization level: United States, 2019

1Significant quadratic trend by urbanization level (p < 0.05).

NOTES: Chronic pain is based on responses of “most days” or “every day” to the survey question, “In the past 3 months, how often did you have pain? Would you 

say never, some days, most days, or every day?” High-impact chronic pain is defined as adults who have chronic pain and who responded “most days” or “every 

day” to the survey question, “Over the past 3 months, how often did your pain limit your life or work activities? Would you say never, some days, most days, or 

every day?” Counties were classified into urbanization levels based on the 2013 NCHS Urban-Rural Classification Scheme for Counties. Estimates are based on 

household interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 4 at: 

https://www.cdc.gov/nchs/data/databriefs/db390-tables-508.pdf#4.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.

22.8

28.1

18.0

16.4

8.0

10.9

6.1 6.4

Percent

Urban Rural Urban Rural

High-impact chronic pain Chronic pain1 1

Large central metro Large fringe metro Medium and small metro Rural

0

5

10

15

20

25

30
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Summary

Overall, the prevalence of chronic pain was 20.4%, and the prevalence of high-impact chronic 

pain was 7.4% (or 36.4% of adults who had chronic pain). Chronic pain was highest among 

women (21.7%), non-Hispanic white adults (23.6%), and those aged 65 and over (30.8%). Highimpact chronic pain was highest among women (8.5%) and those aged 65 and over (11.8%). 

These subgroup differences observed with the 2019 National Health Interview Survey (NHIS) 

are consistent with previously published 2016 NHIS estimates (6). Estimates of chronic pain 

and high-impact chronic pain by level of urbanization examined in this report show that the 

percentage of adults who had chronic pain and high-impact chronic pain in the past 3 months 

increased as place of residence became more rural.

Definitions

Chronic pain: Responses of “most days” or “every day” to the survey question, “In the past 

3 months, how often did you have pain? Would you say never, some days, most days, or 

every day?”

High-impact chronic pain: Adults who have chronic pain and who responded “most days” or 

“every day” to the survey question, “Over the past 3 months, how often did your pain limit your 

life or work activities? Would you say never, some days, most days, or every day?”

Race and ethnicity: Based on two separate questions that determine Hispanic or Latino origin and 

race. Adults of Hispanic or Latino origin may be of any race. Non-Hispanic white, non-Hispanic 

black, and non-Hispanic Asian refer to adults with the single-race group indicated. Non-Hispanic 

American Indian or Alaska Native (AIAN) adults and non-Hispanic Native Hawaiian or Pacific 

Islander (NHPI) adults are included in the totals but are not shown separately.

Urbanization level: Counties were classified according to their metropolitan status using 

the National Center for Health Statistics (NCHS) Urban–Rural Classification Scheme (7). 

Metropolitan (or urban) counties include large central counties (inner cities); the fringes of 

large counties (suburbs); and medium and small counties. Nonmetropolitan (or rural) counties 

include micropolitan statistical areas and noncore areas, including open countryside, rural towns 

(populations of less than 2,500), and areas with populations of 2,500–49,999 that are not part of 

larger labor market areas (metropolitan areas).
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Data source and methods

Data from the redesigned 2019 NHIS were used for this analysis. NHIS is a nationally 

representative, household survey of the civilian noninstitutionalized U.S. population. It is 

conducted continuously throughout the year by NCHS. Data for this analysis are from the pain 

section of the Sample Adult interview (n = 31,997). For more information about NHIS, visit its 

website at: https://www.cdc.gov/nchs/nhis.htm. 

Point estimates and the corresponding variances were calculated using SAS-callable SUDAAN 

version 11.0 (RTI International, Research Triangle Park, N.C.) to account for the complex sample 

design of NHIS. Linear and quadratic trends by age group and size of place of residence were 

evaluated using orthogonal polynomials in logistic regression. Differences between percentages 

were evaluated using two-sided significance tests at the 0.05 level. All estimates presented meet 

NCHS data presentation standards for proportions (8).

About the authors

Carla E. Zelaya, James M. Dahlhamer, Jacqueline W. Lucas, and Eric M. Connor are with the 

National Center for Health Statistics (NCHS), Division of Health Interview Statistics. At the time 

of this report, Eric M. Connor was a guest researcher at NCHS through the Oak Ridge Institute 

for Science and Education fellowship program.
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References

1. Institute of Medicine. Relieving pain in America: A blueprint for transforming prevention, 

care, education, and research. Washington, DC: National Academies Press. 2011. Available from: 

https://www.iprcc.nih.gov/sites/default/files/HHSNational_Pain_Strategy_508C.pdf.

2. U.S. Department of Health and Human Services, National Institutes of Health. Interagency 

Pain Research Coordinating Committee. National pain strategy: A comprehensive population 

health-level strategy for pain. 2016. 

3. Schappert SM, Burt CW. Ambulatory care visits to physician offices, hospital outpatient 

departments, and emergency departments: United States, 2001–02. National Center for Health 

Statistics. Vital Health Stat 13(159):1–66. 2006. 

4. Smith BH, Elliott AM, Chambers WA, Smith WC, Hannaford PC, Penny K. The impact of 

chronic pain in the community. Fam Pract 18:292–9. 2001.

5. Mills SEE, Nicolson KP, Smith BH. Chronic pain: A review of its epidemiology and 

associated factors in population-based studies. Br J Anaesth 123(2):e27383. 2019.

6. Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, DeBar L, et al. Prevalence of chronic 

pain and high-impact chronic pain among adults—United States, 2016. MMWR Surveill Summ 

67(36):1001–06. 2018.

7. Ingram DD, Franco SJ. 2013 NCHS urban–rural classification scheme for counties. National 

Center for Health Statistics. Vital Health Stat 2(166). 2014.

8. Parker JD, Talih M, Malec DJ, Beresovsky V, Carroll M, Gonzalez JF Jr., et al. National 

Center for Health Statistics data presentation standards for proportions. National Center for 

Health Statistics. Vital Health Stat 2(175). 2017.
NCHS Data Brief ■ No. 390 ■ November 2020

Keywords: pain • health disparities • urban-rural • National Health Interview 

Survey (NHIS)

Suggested citation

Zelaya CE, Dahlhamer JM, Lucas JW, 

Connor EM. Chronic pain and high-impact 

chronic pain among U.S. adults, 2019. 

NCHS Data Brief, no 390. Hyattsville, MD: 

National Center for Health Statistics. 2020.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Brian C. Moyer, Ph.D., Director

Amy M. Branum, Ph.D., Acting Associate 

Director for Science

Division of Health Interview Statistics

Stephen J. Blumberg, Ph.D., Director

Anjel Vahratian, Ph.D., M.P.H., Associate 

Director for Science

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