Why is back pain or a knee injury annoying to one person and sheer agony to another? Turns out, an individual's tolerance to pain is as unique as the person, and is shaped by some surprising biological factors, as well as some psychological factors that we can actually try to control.
But for almost everyone, pain is what matters. "It's pain that brings
people into the doctor's office," says Penney Cowan, executive director of
the American Chronic Pain Association. "It's pain that they want
Pain has emerged as a devastating public health problem. According to the
American Chronic Pain Association, pain is the No. 1 cause of adult disability
in the U.S. At least one out of six people live with chronic pain.
Putting a Dollar Sign on Debilitating Pain
Yet estimates for the economic impact of pain vary. A 2003 study published
in The Journal of the American Medical Association put the cost at $61.2
billion per year. But that's only the money drained from U.S. businesses
because of productivity lost from employees in pain. It only included
arthritis, back pain, headache, and other musculoskeletal pain; other kinds of
chronic pain were excluded.
And while looking at pain's bottom line is important, no price can be put on
the enormous suffering it causes.
"The costs are incalculable," says Christopher L. Edwards, PhD,
assistant professor of psychiatry at Duke University School of Medicine.
"How do you estimate the value of lost self-worth? How do you estimate the
loss of family, friends, and a sense of accomplishment?"
What is causing all of this pain -- and cost? For the most part, it's the
And studies show the incidence of pain seems about the same among age
groups. What changes is the type of pain.
For example, people in their 20s and 30s are more likely to suffer from
debilitating headaches. The incidence of back pain peaks in middle age. The
elderly often face arthritis and other painful conditions, like shingles. What
unites these groups is the pain itself -- and the hidden costs that can change
A Hidden Cost of Chronic Pain: Worsening Health
That's because pain can start a vicious cycle that has a direct impact on
Perhaps your knee starts hurting when you walk. The natural response for
many is to walk less. But "if you stop walking, the muscles, tendons and
nerves in your legs atrophy and deteriorate," says Edwards. "If you
become inactive as a result, that leads to all sorts of problems like heart
disease and diabetes."
Just one injury can turn an active, healthy person into an inactive and
Surgery can have the same result. "Many people develop pain after
surgery or after illnesses like shingles," says Steven P. Cohen, MD, an
anesthesiologist in the division of pain medicine at Johns Hopkins School of
Medicine. If they don't get the pain treated promptly, he says, it can become
chronic. And that can lead to yet greater ills.
"People who have chronic pain are exponentially more likely to have
psychiatric illnesses like depression and anxiety disorders," says