“But you don’t look sick!”

“Well, you aren’t in a wheelchair.”

“You’re too young to have the problems you’re talking about.”

These can be some of the frustrating responses patients living with chronic pain receive from people in their networks, including loved ones and even health care workers.

Defined as lasting three months or more, chronic pain can result from numerous conditions (arthritis, migraines, cancer, neurodegenerative diseases, etc.) and affects a significant segment of the population. Here’s what the CDC reports about the prevalence of chronic pain:

• Approximately 100 million Americans live with chronic pain
• Pain affects more Americans than cancer, diabetes, and heart disease combined
• 20.4% of adults experience chronic pain.
• Women are more likely to experience chronic pain than men (21.7% compared to 19%)
• 30% of adults aged 65 and older live with chronic pain.
• 23% of people who have chronic pain are between the ages of 18 and 44.

This September, we want to acknowledge the reality of chronic pain millions of people experience worldwide (including many who use our products to manage their symptoms). Although chronic pain patients often look healthy and carry themselves as though all is well, we recognize that appearances don't always tell the whole story.

Living with Chronic Pain

As disabling as it can feel for a patient, pain is invisible. This is why so many pain patients find themselves arguing with loved ones and doctors about the validity of their condition. Rather than being believed, people living with chronic pain are asked to report their pain levels on a scale from one to ten and are met with suspicion or disbelief if their answers don’t fit the questioner’s expectations.

And there lies one of the central dilemmas pain patients face. They learn to function and live with the pain, creating as normal a life as possible. This comes with the counterproductive effect of convincing people the pain must not be so bad.

The reality is that the impacts of chronic pain are more far-reaching than anyone not living through it can truly understand. Pain touches every aspect of a person’s life, which is why it’s associated with comorbidities like impaired cognition, disordered sleep, limited mobility, and overall reduced quality of life.

Patients with chronic pain experience anxiety and depression and are likely to engage in behaviors that intensify negative moods. Research indicates that over time, untreated or mistreated chronic pain can impair a person’s ability to make complex emotional decisions, lead to abnormal shifts in brain chemistry, and significantly alter the nervous system.

In addition to its emotional cost, pain imposes a heavy economic burden on individual patients and society at large. An American Pain Society report found that chronic pain costs the U.S. approximately $635 billion a year. This number includes the thousands of dollars pain patients spend annually on medical costs along with wages lost due to missed work.

The Inequity of Chronic Pain Treatment

Anyone can experience chronic pain, but that doesn’t make the condition a great equalizer. Chronic pain is experienced differently depending on factors including age, education, economic status, and race. A 2017 Journal of Pain study reported these findings:

• People with less education are more likely to experience chronic pain. 11.2% of adults without a high school diploma reported high-impact chronic pain, versus 6.3% of adults who had post-secondary education.
• Wealthy, white people with chronic pain are better resourced than poor people of color to manage their lives. Only 1% of people in the wealthiest quartile and 12% of white people said their chronic pain interfered with their ability to pay for their needs. On the other hand, 45% of people in the least wealthy quartile, 35% of Black people, and 38% of Latinx people reported that chronic pain impeded their ability to pay for their basic needs.
• Racial inequalities in wealth distribution contribute to the disproportionate impact of pain on people of color. Black and Latinx Americans collectively made up 3% of the wealthiest quartile analyzed in the study. However, they made up 36% of the lowest wealth quartile.

The inequities analyzed in this study illuminate the role socioeconomic status plays in pain management. The wealthier you are, the better equipped you are to manage your symptoms. The intersection of wealth and racial inequality in the United States suggests that chronic pain most negatively impacts economically disadvantaged people of color.

The Trouble with Conventional Pain Therapy

The gold standard of pain treatment is also the substance at the center of the opioid epidemic. Nearly two million Americans have an opioid use disorder, 30% of whom use heroin. About 90 Americans die every day from an opioid overdose.

What’s at the center of this alarming (and increasing) opioid abuse?

According to the National Academies of Sciences, the overprescription of opioid therapies is largely responsible for the opioid crisis impacting communities all over the country. Opioids can be effective therapies for acute pain – postsurgical pain, for example. However, using opioids to treat long-term pain increases a patient's likelihood of becoming dependent on opioids.

In addition to the addictive nature of opioids, pain patients must obtain the financial resources to access treatment. In other words, they need wealth, be it through medical insurance, retirement savings, or another form of steady income. As described earlier, this makes it more difficult for economically disadvantaged chronic pain patients to adequately manage their condition and experience an acceptable quality of life.

Although opioids are the most prescribed way to manage pain, there are a variety of alternative approaches, including the following:

• Physical therapy
• Psychotherapy
• Chiropractic
• Dietary changes
• Exercise
• Massage
• Lifestyle changes
• Alternative drug therapies

Used for thousands of years as a potential analgesic and now legal in most of the United States, cannabis is another alternative pain therapy patients can discuss with their doctors.

Cannabis and Pain

The evidence analyzed in this 2017 report by the National Academies of Sciences, Engineering, and Medicine is the same research many states have used as a basis for including chronic pain as a qualifying medical condition for their medical marijuana programs.

Acknowledging the grief of chronic pain also involves the thorough exploration of all pathways toward relief. Given the complexity and number of pain conditions, no single therapy will resolve chronic pain for everyone. But scientists, researchers, and medical experts should continue exploring and advocating for pain relief safer than opioids, including cannabis and cannabinoids. People living with chronic pain deserve better options than exchanging the grief of pain for the grief of opioid abuse and overdose.