Medically reviewed by Dr. Raymond Osei, MD, MPH
Senior Medical Advisor · Last reviewed January 2025

Chronic pain — pain persisting beyond three to six months or beyond the expected period of healing — is one of the most prevalent and disabling conditions in the United States. The CDC estimates that approximately 20.9% of U.S. adults — about 51.6 million people — have chronic pain. Chronic pain is the leading cause of disability in working-age adults, a major driver of healthcare utilization, and a significant risk factor for depression, anxiety, and opioid use disorder.

Types of Chronic Pain

Chronic pain is categorized by mechanism: nociceptive pain arises from tissue damage or inflammation (arthritis, cancer pain); neuropathic pain arises from damage or dysfunction of the nervous system (diabetic neuropathy, postherpetic neuralgia, radiculopathy); and nociplastic pain — now a recognized category — arises from alterations in pain processing in the central nervous system without clear evidence of tissue damage or nerve injury (fibromyalgia, irritable bowel syndrome, non-specific low back pain).

Chronic Pain and Mental Health

Chronic pain and mental health conditions co-occur at high rates. Depression affects 30–50% of individuals with chronic pain, and the relationship is bidirectional — depression amplifies pain perception through shared neurobiological pathways (serotonin, norepinephrine), and chronic pain causes depression through functional impairment, sleep disruption, and psychosocial consequences. Anxiety disorders, PTSD, and substance use disorders also co-occur at elevated rates.

Chronic Pain and Opioid Use Disorder

The prescription opioid epidemic was largely iatrogenic — arising from aggressive opioid prescribing for chronic pain conditions in the 1990s and 2000s. Current CDC guidelines (updated 2022) emphasize non-opioid treatments as first-line for most chronic pain conditions, appropriate risk assessment before initiating opioids, and the lowest effective dose for the shortest duration when opioids are prescribed. See our article on chronic pain and addiction for a full discussion.

Evidence-Based Non-Opioid Treatments

The evidence base for non-opioid chronic pain management has grown substantially. CBT for chronic pain — particularly Pain Catastrophizing reduction — is among the most effective interventions for functional improvement and quality of life. Physical therapy and graded exercise have strong evidence for low back pain and osteoarthritis. Duloxetine (SNRI) is FDA-approved for diabetic peripheral neuropathy, fibromyalgia, and musculoskeletal pain. Gabapentinoids (gabapentin, pregabalin) have evidence for neuropathic pain. Topical agents (capsaicin, diclofenac) offer localized pain relief with minimal systemic effects. Interventional approaches (nerve blocks, spinal cord stimulation) are appropriate for selected refractory cases.