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The Burden of PainAmong Adultsin the United StatesFindings from the National Health and Nutrition Examination Survey,the National Health Care Surveys, and the National Health Interview Survey

The burden of pain among adults in theUnited States

Over 100 million adults in the United States—51% of the estimated 215 millionpopulation aged 20 years and older—report pain at one or more body sites includingthe joints, low back, neck, face/jaw, or experience dental pain or headaches/migraines.Over one-quarter of adults aged 40 years and older report low back pain in the past

3 months. One-quarter of women aged 20–39 years report having severe headaches or migrainesin the past 3 months.

Numerous diseases and conditions are also associated with pain, including arthritis, peripheralneuropathy, fibromyalgia, and shingles. Annually, there are 5.4 million ambulatory and inpatienthealth care visits with a diagnosis of fibromyalgia, 1.9 million diabetic neuropathy visits, and 1.5million shingles visits. 50% of adults with diabetes who have peripheral neuropathy reportsymptoms of pain/tingling in their feet or numbness/loss of feeling in the past 3 months. 44% ofadults with arthritis report limitations in their usual activities due to their arthritis or joint pain.

Pain may also be caused by bodily injury or harm. In 2006, there were approximately 34 millioninjury-related physician office visits. Analgesic drug therapy was reported at 40% of these injury-related visits.

Adults with pain have worse health status and experience more disability in terms of lost workdays, activity limitations, reduced sleep, and increased psychological distress than adults withoutpain. One in 3 adults with face or jaw pain report fair or poor health status, nearly 1 in 5 adultswith neck pain report being unable to work, and 1 in 9 adults with severe headaches/migrainesreport psychological distress.

This issue of Pfizer Facts presents new analyses of national data sources to gain insight into theburden of pain among adults in the United States. We present information on the prevalence ofpain at specific body sites and certain pain-related diseases and conditions such as arthritis,peripheral neuropathy, fibromyalgia, and shingles, as well as information on associated healthstatus and health care resource utilization. We present analyses of the National Health InterviewSurvey (NHIS), the National Health Care Surveys, and the National Health and NutritionExamination Survey (NHANES). We provide this information in an effort to heighten awarenessand encourage discussion pertaining to pain among adults.

Ryne Paulose, PhDDirector

Robin P. Hertz, PhDSenior Director/Team Leader

Comparative Effectiveness &Population StudiesEvidence-Based Strategies

Table of contents

Highlights 1

Pain at selected body sites 7

Joint pain 9Low back pain 25Neck pain 37Severe headaches or migraines 47Dental pain 57Face or jaw pain 58

Pain and selected diseases or conditions 61

Arthritis 61Peripheral neuropathy 73Diabetic neuropathy 75Fibromyalgia 79Shingles 83Injury 87

Appendix 91

HighlightsPain at selected body sites

• Over one-half of adults aged 20 years and older report feeling pain at one ormore body locations including the joints, back, neck, head, mouth, or face/jaw.Joint pain (28%) and low back pain (26%) are most prevalent.

• Joint pain increases with age and is generally more prevalent among women(31%) than men (26%), and among white, non-Hispanic adults (31%), thanblack, non-Hispanic adults (26%) and Hispanic adults (18%). 29% of adultswith joint pain report having severe pain. The knee is the most common site ofjoint pain regardless of age or gender.

• One in 3 older women and 1 in 4 older men report low back pain in the past 3months. Prevalence increases with body weight—low back pain is reported by about1 in 5 normal weight adults, 1 in 4 overweight adults, and 1 in 3 obese adults.

• 13% of adults report neck pain in the past 3 months. Neck pain is reportedmore often by women (15%) than men (11%) and white, non-Hispanic adults(14%) then black, non-Hispanic adults (10%) or Hispanic adults (11%).

• One in 8 adults report severe headaches or migraines in the past 3 months. It ismore prevalent among women (17%) than men (7%) and adults aged 20–39(15%) and 40–64 (13%) years than adults 65 and older (5%).

• One in 8 adults report dental pain in the past year. Men and women have asimilar prevalence of dental pain regardless of age.

• 4% of adults report facial ache or pain in the jaw muscles or the joint in frontof the ear. Regardless of age, more women (6%) than men (2%) report havingthis type of pain.

Pain at selected body sites and health status

• 25–33% of adults with pain at selected body sites report fair or poor health,15–22% report being unable to work, 12–17% report sleeping less than 6 hoursper day, and 6–13% report psychological distress.

• Also, 29–39% of adults with joint pain, low back pain, and neck pain reportarthritis-attributable activity limitations.

The burden of pain among adults in the United States

1

Pain at selected body sites and health care utilization

• Annually, adults have an average of 11 million physician office visits with adiagnosis of joint pain, over 1.1 million outpatient hospital visits, about 1.5 millionemergency department visits, and have over 177 thousand inpatient hospitalizations.

• Annually, adults have an average of 7 million physician office visits with adiagnosis of back pain, 762 thousand outpatient hospital visits, over 1.5 millionemergency department visits, and have about 227 thousand inpatienthospitalizations.

• Annually, adults have an average of 11 million physician visits with a headachediagnosis, over 1 million outpatient hospital visits, 3.3 million emergencydepartment visits, and 445 thousand inpatient hospitalizations.

• The majority of health care utilization for joint pain, back pain, and headacheswas by women and white, non-Hispanic adults.

Pain at selected body sites and analgesic drug use

• 23–27% of adults with joint pain, low back pain, neck pain, or severeheadaches/migraines report prescription analgesic drug use in the past month.

• 15–22% of adults with joint pain, low back pain, neck pain, or severeheadaches/migraines report using a non-prescription analgesic or certainnon-narcotic prescription analgesics nearly every day for a month or longer.


2

Pain and selected diseases or conditionsArthritis

• 22% of adults aged 20 years and older have been told by a physician or healthprofessional that they have arthritis.

• It is more common among women (25%) than men (18%), older age groups(48%, 65 and older; 25%, 40–64 years) than younger (6%, 20–39 years), andwhite, non-Hispanic adults (25%) than black, non-Hispanic (19%) andHispanic (12%) adults.

• Arthritis is also more common among obese (30%) or overweight (21%) adultsthan normal weight adults (16%).

• 31% of adults with arthritis report fair or poor health compared to 9% ofadults without arthritis. Adults with arthritis are also 11 times more likely toreport arthritis-attributable activity limitations, 5 times more likely to reportbeing unable to work, nearly twice as likely to report reduced hours of sleep,and 3 times as likely to report psychological distress.

• 37% of adults with arthritis report prescription analgesic drug use and 31% usea non-prescription or non-narcotic prescription analgesic nearly every day for amonth or longer.

Peripheral Neuropathy

• 14% of adults aged 40 years and older have peripheral neuropathy; three-fourthsexperience no related symptoms of pain/tingling or numbness in their feet.

• Adults with diabetes have twice the prevalence of peripheral neuropathy asthose with no diabetes (28% vs. 11%, respectively).

• 50% of adults with diabetes who have peripheral neuropathy are symptomaticcompared to less than 20% among adults with no diabetes.


3


4

Diabetic Neuropathy

• Annually, adults have an average of 1.4 million physician office visits with adiagnosis of diabetic neuropathy, 132 thousand outpatient hospital visits, 40thousand emergency department visits, and 392 thousand inpatienthospitalizations.

• The majority of ambulatory and inpatient visits for diabetic neuropathy are bywomen (46–65%), adults aged 40–64 (46–57%), and white, non-Hispanicadults (54–70%).

• An analgesic drug was prescribed, administered, or continued at 37% ofphysician office visits with a primary diagnosis of diabetic neuropathy.

Fibromyalgia

• Annually, there are about 5.4 million health care visits with a fibromyalgiadiagnosis: 4.5 million physician office visits, 390 thousand outpatient hospitalvisits, 413 thousand emergency department visits, and 157 thousand inpatienthospitalizations.

• The majority of this health care utilization is by women, adults aged 40–64 years,and white, non-Hispanic adults. However, emergency departments have relativelymore visits by men, adults aged 20–39, and black, non-Hispanic adults.

• An analgesic drug was prescribed, administered, or continued at 71% of thephysician office visits with a primary diagnosis of fibromyalgia; 29% of officevisits had an antidepressant drug mention and 14% had an anxiolytic, sedative,or hypnotic drug mention.

Shingles

• Annually, adults have about 1.2 million physician office visits and 33 thousandinpatient hospitalizations with a diagnosis of shingles.

• The majority of health care visits are by women, adults aged 40–64 years, andwhite, non-Hispanic adults, with the exception of inpatient hospitalizationswhere over two-thirds are by adults aged 65 and older.

• At over half of all physician office visits with a primary diagnosis of shingles,an analgesic drug was prescribed, administered, or continued.

Injury

• There are ~34 million injury-related physician office visits because of bodysprains or strains, fractures, contusions, dislocations, crushes, or burns.

• Sprains and strains are most common (~17 million office visits), followed byfractures (8 million) and contusions (7 million).

• Analgesic drugs are prescribed, administered, or continued at 40% of injury-related physician office visits.


5


7

Pain at selected body sites

51% of all adults aged 20 years and older report feeling pain at a joint, theirback, neck, head, mouth, or face/jaw. Joint pain and low back pain are mostprevalent (28% and 26%, respectively).

Percent of adult populationSource: NHIS 2007

The Any pain category includes all other pain sites listed. Joint pain prevalence is in the past month; Dental pain is in the past year;all other body sites are in the past 3 months.

Bars with the same values may have different lengths because of rounding.

Any pain

Joint

Low back

Neck

Headache/migraine

Dental

Face/jaw

Prevalence of pain at selected body sites among adults

4

12

12

13

26

28

51

0 10 20 30 40 50 60

Joint pain28% of adults report joint pain, aching, or stiffness in the past month. Joint painincreases with age: 15% among adults aged 20–39 years; 34% among adults aged40–64 years; 44% among those aged 65 and older. Nearly 50% of older women(47%) and older black, non-Hispanic adults (47%) report joint pain.


9

Age, years

Total

20–39

40–64

65+

Prevalence of joint pain in the past month among adults, by gender and age

Percent of adultsSource: NHIS 2007


0 10 20 30 40 50

2826

31

151515

3431

37

4439

47

TotalMenWomen

Age, years

Total

20–39

40–64

65+

Prevalence of joint pain in the past month among adults, by race/ethnicity and age


White, non-HispanicBlack, non-HispanicHispanic

1712

9

3534

27

4547

38

0 10 20 30 40 50

3126

18

One in 4 men and 1 in 3 women with joint pain report having severe pain.

Black, non-Hispanic (44%), and Hispanic (41%) adults with joint pain reportmore severe pain than white, non-Hispanic adults who have joint pain (26%).


10

Percent of adults with joint painSource: NHIS 2006


Total

Men

Women

White,non-Hispanic

Black,non-Hispanic

Hispanic

Prevalence of severe pain among adults with joint pain

12

33

26

29

0 10 20 30 40 50

41

44

26

Weight is associated with joint pain—22% among normal weight adults; 28%among overweight adults; 37% among obese adults.


11

Total

Men

Women

Prevalence of joint pain in the past month among adults, by body weight and gender



0 10 20 30 40 50

2228

37

2226

31

2331

43

NormalOverweightObese

White,non-Hispanic

Black,non-Hispanic

Hispanic

Prevalence of joint pain in the past month among adults, by body weight and race/ethnicity


0 10 20 30 40 50


2531

42

1925

33

1319

24

The knee is the most common site of joint pain regardless of age or gender. This isfollowed by the shoulder for men aged 40 years and older.

Prevalence of joint pain at specific body sites among men aged 20 years and olderby age groups


12

PercentSource: NHIS 2007

ShoulderTotal 820–39 440–64 1065+ 11

ElbowTotal 420–39 240–64 665+ 4

WristTotal 420–39 240–64 565+ 6

HipTotal 420–39 140–64 565+ 9

AnkleTotal 520–39 440–64 665+ 6

KneeTotal 1520–39 840–64 1865+ 23

FingersTotal 520–39 240–64 665+ 9

ToesTotal 220–39 140–64 365+ 3

After the knee, the fingers are the most common site of joint pain for women aged65 years and older.


13

Prevalence of joint pain at specific body sites among women aged 20 years and olderby age groups

PercentSource: NHIS 2007

ShoulderTotal 920–39 340–64 1165+ 15

ElbowTotal 420–39 240–64 665+ 6

WristTotal 620–39 340–64 865+ 8

HipTotal 920–39 340–64 1165+ 14

AnkleTotal 720–39 440–64 865+ 8

KneeTotal 1820–39 940–64 2265+ 29

FingersTotal 920–39 240–64 1165+ 17

ToesTotal 320–39 140–64 465+ 6

Joint pain and health statusJoint pain is associated with substantial activity limitation, work disability, andreduced quality of life. Adults with joint pain are more than 3 times as likely toreport fair/poor health than those with no joint pain (27% vs. 8%, respectively),20 times more likely to report arthritis-attributable activity limitations, 4 timesas likely to report being unable to work, twice as likely to report reduced sleep(<6 hours per day), and 3 times more likely to report psychological distress.


14

Fair/poor health

Limitation of activity due toarthritis or joint symptoms

Unable to work

<6 hours of sleep

Psychological distress

Prevalence of selected health status indicators among adults with or without joint pain



No joint painJoint pain

0 10 20 30 40

8

27

2

39

4

16

6

12

2

6

Over one-half of Hispanic older adults with joint pain report fair or poor healthstatus (56%).


15

Age, years

Total

20–39

40–64

65+

Percent of adults with joint pain who report fair/poor health status, by race/ethnicityand age



0 10 20 30 40 50 60

2439

35

1320

21

2343

35

3447

56

Age, years

Total

20–39

40–64

65+

Percent of adults with joint pain who report fair/poor health status, by gender and age


0 10 20 30 40 50

MenWomen

2529

1219

2528

3835


16

About half of all older adults with joint pain report arthritis-attributable activitylimitations.

Age, years

Total

20–39

40–64

65+

Percent of adults with joint pain who report activity limitations because of arthritis orjoint symptoms, by gender and age


0 10 20 30 40 50 60

MenWomen

3642

1927

3841

4852

Age, years

Total

20–39

40–64

65+

Percent of adults with joint pain who report activity limitations because of arthritis orjoint symptoms, by race/ethnicity and age



0 10 20 30 40 50 60

3945

37

2423

20

3848

39

5058

55


17

More younger adults with joint pain report reduced daily sleep hours (11–16%)than older adults with joint pain (6–9%).

Age, years

Total

20–39

40–64

65+

Percent of adults with joint pain who report less than 6 usual hours of sleep, byrace/ethnicity and age




0 5 10 15 20 25

1018

16

1221

15

1219

18

71212

Age, years

Total

20–39

40–64

65+

Percent of adults with joint pain who report less than 6 usual hours of sleep, by genderand age



0 2 4 6 8 10 12 14 16 18

MenWomen

1212

1116

1412

69


18

Nearly one-third of black, non-Hispanic adults aged 40–64 years with joint painreport being unable to work.

0 5 10 15 20 25 30 35

Age, years

Total

20–39

40–64

Percent of adults with joint pain who report being unable to work, by race/ethnicityand age




1526

17

1012

10

1631

20

Age, years

Total

20–39

40–64

Percent of adults with joint pain who report being unable to work, by gender and age

MenWomen

0 2 4 6 8 10 12 14 16 18 20Percent of adultsSource: NHIS 2007


15

16

9

11

18

18


19

More young women with joint pain experience psychological distress than youngmen with joint pain (9% vs. 4%, respectively).

Age, years

Total

20–39

40–64

65+

Percent of adults with joint pain who report psychological distress, by gender and age



0 1 2 3 4 5 6 7 8 9 10

MenWomen

47

49

58

24

Age, years

Total

20–39

40–64

65+

Percent of adults with joint pain who report psychological distress, by race/ethnicityand age




0 2 4 6 8 10 12 14

56

10

76

8

68

12

33

8

Joint pain and health care utilizationIn 2006, adults made over 11 million physician office visits with a diagnosis ofjoint pain, over 1.1 million outpatient hospital visits, about 1.5 million emergencydepartment visits, and 177 thousand inpatient hospitalizations.

The majority of health care visits for joint pain were by women, adults aged40–64 years, and white, non-Hispanic adults.


20

Percent of physician office visits among adults with a diagnosis of joint pain

Source: NAMCS 2006

20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

25 48 27

67 13 14 6

42 58

Percent of outpatient hospital visits among adults with a diagnosis of joint pain

Source: NHAMCS 2006

Totals may not add to 100% because of rounding.

20–3940–6465+


MenWomen

0% 20% 40% 60% 80% 100%

19 54 26

73 17 10

42 58


21

Percent of emergency department visits among adults with a diagnosis of joint pain

Source: NHAMCS 2006


20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

37 43 20

58 26 12 3

43 57

Percent of inpatient hospitalizations among adults with a diagnosis of joint pain

Source: NHDS 2006


20–3940–6465+

MenWomen

0% 20% 40% 60% 80% 100%

15 34 50

37 63


22

Joint pain and analgesic drug use24% of adults with joint pain report prescription analgesic drug use in the pastmonth.

22% of adults with joint pain report using a non-prescription analgesic or certainnon-narcotic prescription analgesics nearly every day for a month or longer.

Age, years

Total

20–39

40–64

65+

Prevalence of prescription analgesic drug use in the past month among adults withjoint pain in the past year, by gender and age

Percent of adults with joint painSource: NHANES 2003–2004

*Estimate is unreliable due to small sample size.


TotalMenWomen

0 5 10 15 20 25 30 35

2419

28

1610*

22

2521

29

3129

33


23

Age, years

Total

20–39

40–64

65+

Prevalence of frequent monthly use of non-prescription and select prescriptionanalgesics among adults with joint pain in the past year, by gender and age

Percent of adults with joint painSource: NHANES 2003–2004


TotalMenWomen

0 5 10 15 20 25 30 35 40 45

2219

24

107*

12*

2220

23

3840

37

Low back painOver one-quarter of adults report low back pain in the past 3 months (26%). Onein 3 older women and 1 in 4 older men report low back pain.


25

Age, years

Total

20–39

40–64

65+

Prevalence of low back pain in the past 3 months among adults, by gender and age



TotalMenWomen

0 5 10 15 20 25 30 35

2624

28

2220

24

2827

29

3025

33

Age, years

Total

20–39

40–64

65+

Prevalence of low back pain in the past 3 months among adults, by race/ethnicity and age




0 5 10 15 20 25 30 35

282323

2518

19

2827

28

302727


26

Low back pain increases as body weight increases—about 1 in 5 normal weightadults, 1 in 4 overweight adults, and 1 in 3 obese adults report low back pain.

Total

Men

Women

Prevalence of low back pain in the past 3 months among adults, by body weight andgender


0 10 20 30 40

2225

33

2124

28

2327

38


Total

Men

Women

Prevalence of low back pain in the past 3 months among adults, by body weight andrace/ethnicity



0 10 20 30 40

2428

34

2020

29

2021

30


Low back pain and health statusAdults with low back pain are nearly 3 times as likely to report fair or poorhealth than those without back pain (26% vs. 9%, respectively), more than 4times as likely to report arthritis-attributable activity limitations, 4 times as likelyto be unable to work, twice as likely to report reduced sleep (<6 hours per day),and 7 times more likely to report psychological distress.


27

Fair/poor health


Unable to work

<6 hours of sleep


Prevalence of selected health status indicators among adults with or without low back pain


No low back painLow back pain

0 10 20 30

9

26

7

29

4

15

6

13

1

7

Self-rated fair or poor health is reported by about one-half of black, non-Hispanicadults aged 40 years and older and 58% of Hispanic adults aged 65 years andolder with low back pain.


28

Age, years

Total

20–39

40–64

65+

Percent of adults with low back pain who report fair/poor health status, by gender andage


0 10 20 30 40 50

MenWomen

2527

915

2931

4338

Age, years

Total

20–39

40–64

65+

Percent of adults with low back pain who report fair/poor health status, byrace/ethnicity and age



0 10 20 30 40 50 60

2439

27

1020

13

2649

34

3851

58

Arthritis-attributable activity limitations are reported by 50% of older women andabout 60% of older black, non-Hispanic, and Hispanic adults with low back pain.


29

Age, years

Total

20–39

40–64

65+

Percent of adults with low back pain who report activity limitations because of arthritisor joint symptoms, by gender and age


0 10 20 30 40 50 60

MenWomen

26

32

31

38

44

50

9

12

Age, years

Total

20–39

40–64

65+

Percent of adults with low back pain who report activity limitations because of arthritisor joint symptoms, by race/ethnicity and age



0 10 20 30 40 50 60

3034

23

129

5

3444

32

4657

60

Reduced daily sleep hours are reported by 1 in 5 black, non-Hispanic adults withlow back pain, 1 in 7 Hispanic adults, and 1 in 9 white, non-Hispanic adults.


30

Age, years

Total

20–39

40–64

65+

Percent of adults with low back pain who report less than 6 usual hours of sleep, bygender and age


0 2 4 6 8 10 12 14 16 18

MenWomen

1213

1013

1615

69

Age, years

Total

20–39

40–64

65+

Percent of adults with low back pain who report less than 6 usual hours of sleep, byrace/ethnicity and age




0 5 10 15 20 25

1120

14

1118

11

1322

18

713

12


31

About 1 in 5 adults aged 40–64 years with low back pain report being unable towork regardless of gender or race-ethnicity. The exception is black, non-Hispanicadults aged 40–64 years, where over one-third of those with low back pain reportbeing unable to work (35%).

Age, years

Total

20–39

40–64

Percent of adults with low back pain who report being unable to work, by gender and age


MenWomen

0 5 10 15 20 25

1416

58

1922

Age, years

Total

20–39

40–64

Percent of adults with low back pain who report being unable to work, by race/ethnicityand age




0 5 10 15 20 25 30 35 40

1425

12

1935

19

710

5

Older Hispanic adults with low back pain are about 3 times more likely to reportpsychological distress (12%) than older white, non-Hispanic (4%) and black,non-Hispanic (5%) adults with low back pain.


32

Age, years

Total

20–39

40–64

65+

Percent of adults with low back pain who report psychological distress, by gender and age



0 2 4 6 8 10 12

MenWomen

58

47

610

35

Age, years

Total

20–39

40–64

65+

Percent of adults with low back pain who report psychological distress, by race/ethnicityand age




0 2 4 6 8 10 12 14

688

66

5

711

11

45

12

Low back pain and health care utilizationIn 2006, adults made about 7 million physician office visits with a diagnosis ofback pain, 762 thousand outpatient hospital visits, over 1.5 million emergencydepartment visits, and 227 thousand hospitalizations.

The majority of health care visits for back pain were by women, adults aged40–64 years, and white, non-Hispanic adults.


33

Percent of physician office visits among adults with a diagnosis of low back pain

Source: NAMCS 2006


20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

22 59 19

76 15 6 2

45 55

Percent of outpatient hospital visits among adults with a diagnosis of low back pain

Source: NHAMCS 2006


20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

29 58 14

71 18 8

39 61

2


34

Percent of emergency department visits among adults with a diagnosis of low back pain

Source: NHAMCS 2006

20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

41 48 10

66 23 8 3

49 51

Percent of inpatient hospitalizations among adults with a diagnosis of low back pain

Source: NHDS 2006

20–3940–6465+

MenWomen

0% 20% 40% 60% 80% 100%

21 45 34

38 62

Low back pain and analgesic drug use24% of adults with low back pain report prescription analgesic drug use in thepast month.

18% of adults with low back pain report using a non-prescription analgesic orcertain non-narcotic prescription analgesics nearly every day for a month or longer.


35

Age, years

Total

20–39

40–64

65+

Prevalence of prescription analgesic drug use in the past month among adults withlow back pain in the past 3 months, by gender and age

Percent of adults with low back painSource: NHANES 2003–2004; *Estimate is unreliable due to small sample size.

TotalMenWomen

0 5 10 15 20 25 30 35

2421

27

1510*

19

2927

30

3230

32

Age, years

Total

20–39

40–64

65+

Prevalence of frequent monthly use of nonprescription and select prescription analgesicsamong adults with low back pain in the past 3 months, by gender and age

Percent of adults with low back painSource: NHANES 2003–2004; *Estimate is unreliable due to small sample size.


TotalMenWomen

0 5 10 15 20 25 30 35 40 45

1818

19

86*

9*

1921

18

4141

40

Neck pain13% of adults report neck pain in the past 3 months. Neck pain is reported moreoften by women than men (15% vs. 11%, respectively) and white, non-Hispanicadults (14%) than black, non-Hispanic adults (10%) or Hispanic adults (11%).


37

Age, years

Total

20–39

40–64

65+

Prevalence of neck pain in the past 3 months among adults, by gender and age



TotalMenWomen

0 5 10 15 20 25

1311

15

108

12

1613

18

1412

16

Age, years

Total

20–39

40–64

65+

Prevalence of neck pain in the past 3 months among adults, by race/ethnicity and age




0 2 4 6 8 10 12 14 16 18 20

1410

11

126

7

1613

16

1412

17


38

Neck pain and health statusAdults with neck pain are more than twice as likely to report fair or poor healththan those without neck pain (29% vs. 11%, respectively), nearly 4 times as likelyto report arthritis-attributable activity limitations, nearly 4 times as likely toreport being unable to work, more than twice as likely to report reduced sleep(<6 hours per day), and 4 times more likely to report psychological distress.

Fair/poor health


Unable to work

<6 hours of sleep


Prevalence of selected health status indicators among adults with or without neck pain


No neck painNeck pain

0 10 20 30 40

11

29

9

34

5

18

6

14

2

8


39

Self-rated fair/poor health is reported by 55% of black, non-Hispanic adults aged40–64 years and 60% of Hispanic adults aged 65 years and older with neck pain.

Age, years

Total

20–39

40–64

65+

Percent of adults with neck pain who report fair/poor health status, by gender and age


0 10 20 30 40 50

MenWomen

2930

1017

3533

4339

Age, years

Total

20–39

40–64

65+

Percent of adults with neck pain who report fair/poor health status, by race/ethnicityand age



0 10 20 30 40 50 60 70

2648

36

1228

14

3055

45

3759

60


40

Arthritis-attributable activity limitations are reported by nearly two-thirds ofolder black, non-Hispanic and Hispanic adults (64%), and one-half of olderwhite, non-Hispanic adults (48%) with neck pain.

Age, years

Total

20–39

40–64

65+

Percent of adults with neck pain who report activity limitations because of arthritis orjoint symptoms, by gender and age



0 10 20 30 40 50 60

MenWomen

3336

4040

4654

1116

Age, years

Total

20–39

40–64

65+

Percent of adults with neck pain who report activity limitations because of arthritis orjoint symptoms, by race/ethnicity and age




0 10 20 30 40 50 60 70

3446

35

1515

11

3956

44

4864

64


41

Reduced daily sleep hours are reported by 1 in 4 black, non-Hispanic adults withneck pain, 1 in 5 Hispanic adults, and 1 in 8 white, non-Hispanic adults withneck pain.

Age, years

Total

20–39

40–64

65+

Percent of adults with neck pain who report less than 6 usual hours of sleep, by genderand age



0 2 4 6 8 10 12 14 16 18

MenWomen

1415

1214

1717

611

Age, years

Total

20–39

40–64

65+

Percent of adults with neck pain who report less than 6 usual hours of sleep, byrace/ethnicity and age




0 5 10 15 20 25 30

1325

19

1224

16

1527

21

817

15


42

Nearly one-quarter of adults aged 40–64 years with neck pain and one-third ofblack, non-Hispanic adults with neck pain report being unable to work.

Age, years

Total

20–39

40–64

Percent of adults with neck pain who report being unable to work, by gender and age



MenWomen

0 5 10 15 20 25 30

18

18

6

8

24

24

0 5 10 15 20 25 30 35 40 45

Age, years

Total

20–39

40–64

Percent of adults with neck pain who report being unable to work, by race/ethnicityand age



1733

17

2241

25

715

5

More women with neck pain report psychological distress than men (10% vs.5%, respectively).

More black, non-Hispanic adults (13%) and Hispanic adults (12%) with neckpain report psychological distress than white, non-Hispanic adults (7%).


43

Age, years

Total

20–39

40–64

65+

Percent of adults with neck pain who report psychological distress, by gender and age


0 2 4 6 8 10 12

MenWomen

510

49

712

26

Age, years

Total

20–39

40–64

65+

Percent of adults with neck pain who report psychological distress, by race/ethnicityand age




0 2 4 6 8 10 12 14 16 18

713

12

610

7

817

16

45

12


44

Neck pain and analgesic drug use27% of adults with neck pain report prescription analgesic drug use in the past month.

21% of adults with neck pain report using a non-prescription analgesic or certainnon-narcotic prescription analgesics nearly every day for a month or longer.

Age, years

Total

20–39

40–64

65+

Prevalence of prescription analgesic drug use in the past month among adults withneck pain in the past 3 months, by gender and age

Percent of adults with neck painSource: NHANES 2003–2004


TotalMenWomen

0 5 10 15 20 25 30 35 40

2722

31

179*

24

3533

36

2825

30


45

Age, years

Total

20–39

40–64

65+

Prevalence of frequent monthly use of nonprescription and select prescription analgesicsamong adults with neck pain in the past 3 months, by gender and age

Percent of adults with neck painSource: NHANES 2003–2004



TotalMenWomen

0 5 10 15 20 25 30 35 40 45 50

2119

23

129*

15*

2222

23

4144

38

Severe headaches or migrainesOne in 8 adults report severe headaches or migraines in the past 3 months. Womenare more than twice as likely as men to report severe headaches or migraines (17%vs. 7%, respectively). Older adults are less likely to report severe headaches ormigraines (5%) than adults aged 20–39 (15%) and 40–64 (13%) years.


47

Age, years

Total

20–39

40–64

65+

Prevalence of severe headaches or migraines in the past 3 months among adults, bygender and age


TotalMenWomen

0 5 10 15 20 25

127

17

158

22

138

18

53

6

Age, years

Total

20–39

40–64

65+

Prevalence of severe headaches or migraines in the past 3 months, by race/ethnicityand age




0 2 4 6 8 10 12 14 16 18

1212

12

1613

10

1312

14

47

8


48

Severe headaches or migraines and health statusAdults with severe headaches or migraines are more than twice as likely to reportfair or poor health than those without headaches or migraines (25% vs. 12%,respectively), more than 3 times as likely to be unable to work, about 3 times aslikely to report reduced sleep (<6 hours per day), and 5 times as likely to reportpsychological distress.

Fair/poor health

Unable to work

<6 hours of sleep


Percent of selected health status indicators among adults with or without severeheadaches or migraines


No headache/migraineHeadache/migraine

0 10 20 30

12

25

5

16

6

16

2

10

Self-rated fair or poor health is reported by one-third of adults aged 40–64 yearsand 49% of older adults with severe headaches or migraines. 60% of older black,non-Hispanic adults and 69% of older Hispanic adults with severe headaches ormigraines report fair or poor health status.


49

Age, years

Total

20–39

40–64

65+

Percent of adults with severe headaches or migraines who report fair or poor healthstatus, by gender and age


0 10 20 30 40 50 60

MenWomen

25

26

8

17

36

32

48

49

Age, years

Total

20–39

40–64

65+

Percent of adults with severe headaches or migraines who report fair or poor healthstatus, by race/ethnicity and age



0 10 20 30 40 50 60 70 80

2335

32

1222

17

3045

44

4460

69


50

Men aged 65 years and older with severe headaches or migraines are twice aslikely to report reduced daily sleep hours than women aged 65 years and older(14% vs. 7%, respectively).

Age, years

Total

20–39

40–64

65+

Percent of adults with severe headaches or migraines who report less than 6 usual hoursof sleep, by gender and age


0 5 10 15 20 25

MenWomen

17

15

1612

1918

147

Age, years

Total

20–39

40–64

65+

Percent of adults with severe headaches or migraines who report less than 6 usual hoursof sleep, by race/ethnicity and age



0 5 10 15 20 25 30

1521

16

1418

11

1726

22

810

14


51

One in 3 black, non-Hispanic adults aged 40–64 years with severe headaches ormigraines, 1 in 4 Hispanic adults, and 1 in 5 white, non-Hispanic adults reportbeing unable to work.

Age, years

Total

20–39

40–64

Percent of adults with severe headaches or migraines who report being unable to work,by gender and age


MenWomen

0 5 10 15 20 25 30

1815

68

2721

Age, years

Total

20–39

40–64

Percent of adults with severe headaches or migraines who report being unable to work,by race/ethnicity and age



0 5 10 15 20 25 30 35 40

1522

16

2134

26

810

6


52

Older women with severe headaches or migraines are 55% more likely to reportpsychological distress (14%) than older men (9%). Nearly one-third of Hispanicolder adults with severe headaches or migraines report psychological distresscompared to 19% of older black, non-Hispanic adults and 9% of older white,non-Hispanic adults.

Age, years

Total

20–39

40–64

65+

Percent of adults with severe headaches or migraines who report psychological distress,by gender and age



0 2 4 6 8 10 12 14 16

MenWomen

1110

109

1211

914

Age, years

Total

20–39

40–64

65+

Percent of adults with severe headaches or migraines who report psychological distress,by race/ethnicity and age




0 5 10 15 20 25 30 35

1013

14

109

7

1016

18

919

30

Severe headaches or migraines and health careutilizationIn 2006, adults made nearly 11 million physician visits with a headache diagnosis,over 1 million outpatient hospital visits, 3.3 million emergency department visits,and 445 thousand inpatient hospitalizations.

The majority of health care visits for headaches were by women and white, non-Hispanic adults. Physician office visits and inpatient hospitalizations were mostlymade by adults aged 40–64 years, whereas a larger proportion of outpatienthospital and emergency department visits were by those aged 20–39 years.


53

Percent of outpatient hospital visits among adults with a diagnosis of headache

Source: NHAMCS 2006


20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

46 44 10

66 16 14

30 70

3

Percent of physician office visits among adults with a diagnosis of headache

Source: NAMCS 2006


20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

34 54 11

76 10 12 3

26 74


54

Percent of emergency department visits among adults with a diagnosis of headache

Source: NHAMCS 2006


20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

51 41 8

70 19 8 2

25 75

Percent of inpatient hospitalizations among adults with a diagnosis of headache

Source: NHDS 2006


20–3940–6465+

MenWomen

0% 20% 40% 60% 80% 100%

36 50 14

22 77

Severe headaches/migraines and analgesic drug use23% of adults with severe headaches/migraines report prescription analgesic druguse in the past month.

15% of adults with severe headaches/migraines report using a non-prescription analgesicor certain non-narcotic prescription analgesics nearly every day for a month or longer.


55

Age, years

Total

20–39

40–64

65+

Prevalence of prescription analgesic drug use in the past month among adults withsevere headaches/migraines in the past 3 months, by gender and age

Percent of adults with severe headaches/migrainesSource: NHANES 2003–2004; *Estimate is unreliable due to small sample size.

TotalMenWomen

0 5 10 15 20 25 30 35 40

2321

24

1511*

16

3029

31

3528*

38*

Age, years

Total

20–39

40–64

65+

Prevalence of frequent monthly use of nonprescription and select prescription analgesicsamong adults with severe headaches/migraines in the past 3 months, by gender and age

Percent of adults with severe headaches/migrainesSource: NHANES 2003–2004; *Estimate is unreliable due to small sample size.


TotalMenWomen

0 5 10 15 20 25 30 35 40

151515

97*

10*

1820

17

3534*

35

Dental painOne in 8 adults experienced dental pain in the past year. Men and women have asimilar prevalence of dental pain regardless of age.


57

Age, years

Total

20–39

40–64

65+

Prevalence of dental pain in the past year among adults, by gender and age



TotalMenWomen

0 2 4 6 8 10 12 14 16

1211

13

1312

14

1312

13

88

9

Age, years

Total

20–39

40–64

65+

Prevalence of dental pain in the past year among adults, by race/ethnicity and age




0 2 4 6 8 10 12 14 16

1212

10

1511

10

1313

11

81010

Face or jaw pain4% of adults report facial ache or pain in the jaw muscles or the joint in frontof the ear. Women are three times as likely as men to report this type of pain(6% vs. 2%, respectively).


58

Age, years

Total

20–39

40–64

65+

Prevalence of face or jaw pain in the past 3 months among adults, by gender and age



TotalMenWomen

0 1 2 3 4 5 6 7

42

6

42

6

53

6

31

4

Age, years

Total

20–39

40–64

65+

Prevalence of face or jaw pain in the past 3 months among adults, by race/ethnicityand age





0 1 2 3 4 5 6

43

3

52

3

54

4

33*

4*


59

Adults with face or jaw pain are 2.5 times more likely to report fair or poorhealth status than adults with no pain (33% vs. 13%, respectively), nearly 4 timesas likely to be unable to work, more than twice as likely to have reduced sleep(<6 hours per day), and nearly 7 times as likely to report psychological distress.

Fair/poor health

Unable to work

<6 hours of sleep


Prevalence of selected health status indicators among adults with or without face orjaw pain


No face/jaw painFace/jaw pain

0 10 20 30 40

13

33

6

22

7

17

2

13

Pain and selected diseases orconditions

Arthritis47.3 million adults have diagnosed arthritis (22%). Arthritic conditions such asosteoarthritis and rheumatoid arthritis are characterized by joint pain in theextremities.

The prevalence is higher among women (25%) than men (18%), older age groups(48%, 65 and older; 25%, 40–64 years) than younger age groups (6%, 20–39years), and white, non-Hispanic adults (25%) than black, non-Hispanic (19%)and Hispanic (12%) adults.

Prevalence of arthritis is greater among adults who are obese (30%) or overweight(21%) than adults who are normal weight (16%).


61

Age, years

Total

20–39

40–64

65+

Prevalence of arthritis among adults, by gender and age


TotalMenWomen

0 10 20 30 40 50 60

2218

25

65

7

2521

28

4841

52


62

Age, years

Total

20–39

40–64

65+

Prevalence of arthritis among adults, by race/ethnicity and age



0 10 20 30 40 50 60

2519

12

74

3

2724

19

4952

38


63

White,non-Hispanic

Black,non-Hispanic

Hispanic

Prevalence of arthritis among adults, by body weight and race/ethnicity



0 10 20 30 40

1824

35

1218

26

912

15


Total

Men

Women

Prevalence of arthritis among adults, by body weight and gender


0 10 20 30 40

1621

30

1317

24

1826

36



64

Arthritis and health statusArthritis is a leading cause of disability and is associated with substantial activitylimitation, work disability and reduced quality of life. Adults with arthritis aremore than 3 times as likely to report fair or poor health than those withoutarthritis (31% vs. 9%, respectively), 11 times more likely to report arthritis-attributable activity limitations, 5 times more likely to report being unable towork, nearly twice as likely to report reduced hours of sleep (<6 hours per day),and 3 times as likely to report psychological distress.

Fair/poor health


Unable to work

<6 hours of sleep


Prevalence of selected health status indicators among adults with or without arthritis



No arthritisArthritis

0 10 20 30 40 50

9

31

4

44

4

20

6

11

2

6

Self-rated fair or poor health is reported by about 1 in 3 adults with arthritis. Theprevalence generally increases with age regardless of gender or race/ethnicity.


65

Age, years

Total

20–39

40–64

65+

Percent of adults with arthritis who report fair/poor health status, by gender and age


0 10 20 30 40 50

MenWomen

3032

1528

2932

3634

Age, years

Total

20–39

40–64

65+

Percent of adults with arthritis who report fair/poor health status, by race/ethnicityand age




0 10 20 30 40 50 60

2942

45

2028

34

2844

43

3243

55


66

42% of men and 46% of women with arthritis report arthritis-related activitylimitations. 52% of black, non-Hispanic adults with arthritis and 48% ofHispanic adults with arthritis report being limited in their usual daily activities.

Age, years

Total

20–39

40–64

65+

Percent of adults with arthritis who report activity limitations because of arthritis orjoint symptoms, by gender and age



0 10 20 30 40 50 60

MenWomen

4246

4346

4450

3131

Age, years

Total

20–39

40–64

65+

Percent of adults with arthritis who report activity limitations because of arthritis orjoint symptoms,, by race/ethnicity and age



0 10 20 30 40 50 60

4352

48

3136

33

4454

47

4654

58


67

More young adults with arthritis report reduced daily sleep hours (16%) thanadults aged 40–64 years (13%) and adults aged 65 and older (7%) with arthritis.

Age, years

Total

20–39

40–64

65+

Percent of adults with arthritis who report less than 6 usual hours of sleep, by genderand age



0 2 4 6 8 10 12 14 16 18

MenWomen

1111

1517

1313

68

Age, years

Total

20–39

40–64

65+

Percent of adults with arthritis who report less than 6 usual hours of sleep, byrace/ethnicity and age




0 5 10 15 20 25

1017

18

1622

19

112020

612

15


68

20% of adults with arthritis report being unable to work. Nearly one-third ofblack, non-Hispanic adults aged 40–64 years with arthritis report being unable towork (32%).

Age, years

Total

20–39

40–64

Percent of adults with arthritis who report being unable to work, by gender and age


MenWomen

0 5 10 15 20 25

1921

1016

20

22

Age, years

Total

20–39

40–64

Percent of adults with arthritis who report being unable to work, by race/ethnicity and age




1929

20

2032

21

141414

0 5 10 15 20 25 30 35

1929

20

141414

2032

21

6% of adults with arthritis report psychological distress. Generally, the prevalencedeclines with age and is greatest among women (7%) and Hispanic adults (11%).


69

Age, years

Total

20–39

40–64

65+

Percent of adults with arthritis who report psychological distress, by gender and age



0 2 4 6 8 10 12

MenWomen

47

69

410

23

Age, years

Total

20–39

40–64

65+

Percent of adults with arthritis who report psychological distress, by race/ethnicityand age




0 2 4 6 8 10 12 14 16

56

11

84

14

78

12

23

10


70

Arthritis and analgesic drug use37% of adults with arthritis report prescription analgesic drug use.

31% of adults with arthritis report using a non-prescription or non-narcoticprescription analgesic nearly every day for a month or longer.

Age, years

Total

40–64

65+

Prevalence of prescription analgesic drug use in the past month among adults witharthritis, by gender and age*

Percent of adults with arthritisSource: NHANES 2003–2004

*Estimates for 20–39 year age group are unreliable due to small sample size and are not shown.

TotalMenWomen

0 5 10 15 20 25 30 35 40 45 50

3735

38

4239

44

3433

35


71

Age, years

Total

40–64

65+

Prevalence of current frequent monthly use of nonprescription and select prescriptionnon-narcotic analgesics among adults with arthritis, by gender and age*

Percent of adults with arthritisSource: NHANES 2003–2004

*Estimates for 20–39 year age group are unreliable due to small sample size and are not shown.


TotalMenWomen

0 5 10 15 20 25 30 35 40 45

313131

2829

27

4041

39


73

Peripheral neuropathy14% of adults aged 40 years and older have peripheral neuropathy;about three fourths are asymptomatic.

Based on monofilament testing, 14% of adults have peripheral neuropathy,damage to nerves that carry information from the brain and spinal cord to otherparts of the body. It is more than twice as prevalent among adults with diabetes asadults with no diabetes (28% vs. 11%, respectively).

50% of adults with diabetes who have peripheral neuropathy report havingpain/tingling in their feet or numbness/loss of feeling in the prior 3 months (14%symptomatic; 14% asymptomatic).

Total

No Diabetes

Diabetes

Total

No Diabetes

Diabetes

Total

No Diabetes

Diabetes

Prevalence of peripheral neuropathy among adults aged 40 years and older by diabetesstatus and age

PercentSource: NHANES 1999-2004; Symptomatic persons reported numbness/loss of feeling or painful sensations/tinglingin feet during the preceding 3 months.

AsymptomaticSymptomatic

0 5 10 15 20 25 30 35 40

Tota

l40

–64

65+

10 4

9 2

14 14

7 2

6 2

10 11

18 7

17 5

20 18


74

Total

No Diabetes

Diabetes

Total

No Diabetes

Diabetes

Prevalence of peripheral neuropathy among adults aged 40 years and older by diabetesstatus and gender

PercentSource: NHANES 1999–2004


0 5 10 15 20 25 30 35 40

Wom

enM

en

7 3

7 2

12 11

13 5

12 3

17 17

Total

No Diabetes

Diabetes

Total

No Diabetes

Diabetes

Total

No Diabetes

Diabetes

Prevalence of peripheral neuropathy among adults aged 40 years and older by diabetesstatus and race/ethnicity

PercentSource: NHANES 1999–2004


0 5 10 15 20 25 30 35 40

Whi

te,

non-

Hisp

anic

Blac

k,no

n-Hi

span

icM

exic

anAm

eric

an

10 4

9 3

14 16

12 4

11 2

14 13

10 4

9 2

15 11


75

Diabetic neuropathyAnnually, there are 1.4 million physician office visits by adults aged 20 years andolder with a diagnosis of diabetic neuropathy. Diabetic neuropathy is damage tothe peripheral nerves that occurs secondary to vascular problems that occur withdiabetes. Additionally, there are an average of 132 thousand outpatient hospitalvisits, 40 thousand emergency department visits, and 392 thousand inpatienthospitalizations with a diagnosis of diabetic neuropathy.

The majority of ambulatory and inpatient visits for diabetic neuropathy are bywomen (46–65%), adults aged 40–64 years (46–57%), and white, non-Hispanicadults (54–70%).

37% of physician office visits with a primary diagnosis of diabetic neuropathyhave an analgesic drug mention, that is, an analgesic drug was prescribed,administered, or continued.

Number of visits, in thousandsSource: 2002–2006: NAMCS, NHAMCS, NHDS

Physician office

Outpatient hospital

Emergency room

Inpatient hospitalization

Annual number of medical visits by adults aged 20 years and older with a diagnosis ofdiabetic neuropathy by type of visit

392

132

40

0 200 400 600 800 1000 1200 1400 1600

1,359


76

Percent of physician office visits among adults with a diagnosis of diabetic neuropathy

Source: NAMCS 2002–2006

*Estimate is unreliable because of small sample size.


20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

1* 50 49

70 20 8* 3*

50 50

Percent of outpatient hospital visits among adults with a diagnosis of diabetic neuropathy

Source: NHAMCS 2002–2006



20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

8* 55 38

67 18 10*

54 46

5*


77

Percent of emergency department visits among adults with a diagnosis of diabeticneuropathy




20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

19 57 24

54 30 15* 1

35* 65

Percent of inpatient hospitalizations among adults with a diagnosis of diabetic neuropathy

Source: NHDS 2002–2006

20–3940–6465+

MenWomen

0% 20% 40% 60% 80% 100%

9 46 45

48 52


79

FibromyalgiaMore than six million adults have fibromyalgia, a disorder characterized byfatigue, stiffness, joint tenderness, and widespread muscle pain.

Annually, there are 4.5 million physician office visits by adults aged 20 years andolder, 390 thousand outpatient hospital visits, 413 thousand emergency departmentvisits, and 157 thousand inpatient hospitalizations with a diagnosis of fibromyalgia.

71% of physician office visits with a primary diagnosis of fibromyalgia had ananalgesic drug mention, that is, an analgesic drug was prescribed, administered,or continued; 29% had an antidepressant mention and 14% had an anxiolytic,sedative, or hypnotic drug mention.

The majority of visits with a fibromyalgia diagnosis are made by women (76–87%),adults aged 40–64 years (60–62%), and white, non-Hispanic adults (73–82%).The exception is emergency department visits which have relatively more men,adults aged 20–39 years, and black, non-Hispanic adults, when compared withother types of visits.

Number of visits, in thousandsSource: 2002–2006: NAMCS, NHAMCS, NHDS.

Physician office

Outpatient hospital

Emergency room


Number of medical visits by adults aged 20 years and older with a diagnosis of fibromyalgiaby type of visit

157

390

4,480

413

0 1000 2000 3000 4000 5000


80

Percent of physician office visits among adults with a diagnosis of fibromyalgia




20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

19 62 20

82 8 7 3*

22 78

Percent of outpatient hospital visits among adults with a diagnosis of fibromyalgia



20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

26 61 13

73 14 11

24 76

2*

Percent of inpatient hospitalizations among adults with a diagnosis of fibromyalgia



20–3940–6465+

MenWomen

0% 20% 40% 60% 80% 100%

16 60 23

13 87


81

Percent of emergency department visits among adults with a diagnosis of fibromyalgia



20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

42 47 11

55 30 13 2*

39 61

Analgesics

Antidepressants

Anxiolytics, sedatives,hypnotics

Percent of fibromyalgia office visits with a drug mention for analgesics, antidepressants,or anxiolytics/sedatives/hypnotics

Percent of fibromyalgia-related office visitsSource: NAMCS 2006*Estmate is unreliable because of small sample size.

0 20 40 60 80

Primary diagnosisAny diagnosis

7163

29*30

14*20


83

ShinglesAnnually, there are 1.2 million physician office visits by adults aged 20 years andolder with a diagnosis of shingles, a viral disease characterized by a painful skinrash. Annually, there are an additional 107 thousand outpatient hospital visits,157 thousand emergency department visits, and 33 thousand inpatienthospitalizations with a diagnosis of shingles.

58% of physician office visits with a primary diagnosis of shingles had ananalgesic drug mention, that is, an analgesic drug was prescribed, administered,or continued.

The majority of visits for shingles are by women (54–65%), adults aged 40–64years (32–44%), and white, non-Hispanic adults (62–85%). The exception is withinpatient hospitalizations, where over two-thirds of the hospitalizations with ashingles diagnosis are by adults aged 65 and older.

Number of visits, in thousandsSource: 2002–2006: NAMCS, NHAMCS, NHDS.

Physician office

Outpatient hospital

Emergency room


Annual number of medical visits by adults aged 20 years and older with a diagnosis ofshingles, by type of visit

33

107

0 200 400 600 800 1000 1200 1400

1,154

157


84

Percent of physician office visits among adults with a diagnosis of shingles




20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

15* 32 53

84 6* 8* 3*

42 58

Percent of outpatient hospital visits among adults with a diagnosis of shingles



20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

22* 34 44

85 3* 9*

37 63

3*


85

Percent of emergency department visits among adults with a diagnosis of shingles




20–3940–6465+


MenWomen

Other0% 20% 40% 60% 80% 100%

26 44 31

62 20 13 4*

46 54

Percent of inpatient hospitalizations among adults with a diagnosis of shingles


20–3940–6465+

MenWomen

0% 20% 40% 60% 80% 100%

5 26 69

35 65


87

InjuryIn 2006, there were nearly 34 million physician office visits for a bodily injury,which includes sprains or strains, fractures, contusions, dislocations, crushes, orburns. Sprains and strains are the most common type of injury, with nearly 17million office visits. This was followed by 8 million visits with a fracture diagnosisand 7 million for a contusion.

14 million or 43% of all injury-related office visits had an analgesic drug mention,that is, an analgesic drug was prescribed, administered, or continued during theoffice visit. 53% of sprain/strain visits had an analgesic drug mention.

Any injury*

Sprains and strains

Fractures

Superficial contusion

Dislocation

Number of physician office visits by adults aged 20 years and older with an injury-relateddiagnosis and analgesic drug mention

Physician office visits, in millionsSource: NAMCS 2006

*Includes all injuries shown and bodily crushes and burns.

Total # of office visitsVisits with analgesic drug mention

0 5 10 15 20 25 30 35

34

17

8

7

2

14

9

3

2

1


88

PercentSource: NAMCS 2006

Men

Women

20–39

40–64

65+

White,non-Hispanic

Black,non-Hispanic

Hispanic

Percent of analgesic drug mentions among office visits with any primary injury-relateddiagnosis

0 5 10 15 20 25 30 35 40 45 50

47

42

34

42

42

41

31

46


89

PercentSource: NAMCS 2006


Men

Women

20–39

40–64

65+

White,non-Hispanic

Black,non-Hispanic

Hispanic

Percent of analgesic drug mentions among office visits with a primary injury-relateddiagnosis of strains and sprains

0 10 20 30 40 50 60

55

53

45*

54

51

52

36*

55

Appendix

Data sourcesNational Health and Nutrition Examination Survey (NHANES), 1999–2004US Department of Health and Human ServicesCenters for Disease Control and PreventionNational Center for Health Statistics

The NHANES is a sample survey designed to obtain nationally representative information onthe health and nutrition of the civilian, non-institutionalized population of the United States.It is conducted by the National Center for Health Statistics (NCHS), a part of the Centers forDisease Control and Prevention (CDC). Survey participants receive a face-to-face interview intheir homes to obtain information on health history, health behaviors, and risk factors.Participants subsequently undergo a physical examination in a mobile examination center.The survey is conducted in 2-year cycles. The 1999–2004 survey is an aggregation of thethree most recent releases of NHANES (1999–2000, 2001–2002, and 2003–2004). The totalpopulation of adults aged 20 years and older sampled during the 2003–2004 cycle is 5041,including 1494 persons aged 65 and older. The total population of adults aged 40 years andolder sampled during the 1999–2004 cycle is 9970.

National Health Care Surveys:US Department of Health and Human ServicesCenters for Disease Control and PreventionNational Center for Health Statistics

National Ambulatory Medical Care Survey (NAMCS), 2002–2006The NAMCS is a national survey of physicians designed to meet the need for objective,reliable information about the provision and use of ambulatory medical care services inthe United States. It is conducted by the National Center for Health Statistics (NCHS), apart of the Centers for Disease Control and Prevention (CDC). Findings are based on asample of visits to non-federally employed office-based physicians who are primarilyengaged in direct patient care. Physicians in the specialties of anesthesiology, pathology,and radiology are excluded from the survey. The survey was conducted annually from1973 to 1981, in 1985, and annually since 1989. The sample size for adults aged 20years and older for 2006 is 23,819 visits and for 2002–2006 is 109,041 visits.


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National Hospital Ambulatory Medical Care Survey (NHAMCS), 2002–2006The NHAMCS, begun in 1992, is the longest continuously running nationally representativesurvey of visits to the emergency and outpatient departments of noninstitutional generaland short-stay hospitals, exclusive of Federal, military, and Veterans Administration hospitalsin the 50 States and the District of Columbia. An outpatient department is a hospitalfacility where nonurgent ambulatory medical care is provided under the supervision ofa physician. The following are examples of the types of clinics included in NHAMCS:general medicine, surgery, pediatrics, obstetrics and gynecology, substance abuse (excludingmethadone maintenance), and others (e.g., psychiatry and neurology). Clinics excludedfrom NHAMCS include ambulatory surgery centers, chemotherapy, employee healthservice, renal dialysis, methadone maintenance, and radiology. Data are released as twoseparate files, the emergency department data file and the outpatient department data file.The sample size for emergency department visits for adults aged 20 years and older for2006 is 25,465 and 2002–2006 is 133,074. The sample size for outpatient departmentvisits for adults aged 20 years and older for 2006 is 24,630 and 2002–2006 is 121,643.

National Hospital Discharge Survey (NHDS), 2002–2006The NHDS, which has been conducted annually since 1965, is a national probabilitysurvey of inpatients discharged from non-Federal short-stay hospitals in the UnitedStates. The NHDS collects data from a sample of more than 300,000 inpatient recordsacquired from a national sample of about 500 hospitals. Data are available on patientcharacteristics including age, race, and sex; administrative information including patientdisposition, expected sources of payment, and source of admission; and medical informationincluding diagnoses and procedures. Sample size for adults aged 20 and older for 2006 is301,075 records and for 2002–2006 is 1,398,311 records.

National Health Interview Survey (NHIS), 2007US Department of Health and Human ServicesCenters for Disease Control and PreventionNational Center for Health Statistics

The NHIS is a nationally representative interview survey based on a sample of the non-institutionalized US population. Surveys in the series have been conducted annually since1957, with the last major restructuring occurring in 1997. The survey consists of personalinterviews in a population-based national sample. The 2007 sample consists of 22,814 adultsaged 20 and older, with 8,285 between the ages of 20 to 39, and 4,583 aged 65 and older.


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DefinitionsPain sitesDental pain: Persons were classified as having dental pain if they responded positively to theNHIS question, “During the past 12 months, have you had dental pain?”

Face or jaw pain: Persons were classified as having face or jaw pain if they responded positivelyto the NHIS question, “During the past 3 months, did you have facial ache or pain in the jawmuscles or the joint in front of the ear?” Respondents were instructed to report pain that hadlasted a whole day or more, and not to report fleeting or minor aches or pains

Joint pain: Persons were classified as having joint pain if they responded positively to theNHIS question, “During the past 30 days, have you had any symptoms of pain, aching,stiffness in or around a joint?’’ Respondents were instructed to report the affected jointsbut not to include the back or neck. On the NHANES, the question asked about joint painduring the past 12 months.

Severe joint pain was defined based on the NHIS 2006 follow-up question, “During the past30 days, how bad was your joint pain on average?’’ Respondents were instructed to answeron a scale of 0–10 where 0 was no pain or aching and 10 was pain or aching as bad as it canbe. Severe pain was defined as a response of 7–10.

Low back pain: Persons were classified as having low back pain if they responded positively tothe NHIS or NHANES question, “During the past 3 months, did you have low back pain?”Respondents were instructed to report pain that had lasted a whole day or more, and not toreport fleeting or minor aches or pains.

Neck pain: Persons were classified as having neck pain if they responded positively to theNHIS or NHANES question, “During the past 3 months, did you have neck pain?”Respondents were instructed to report pain that had lasted a whole day or more, and notto report fleeting or minor aches or pains.

Severe headaches or migraines: Persons were classified as having severe headache or migraineif they responded positively to the NHIS or NHANES question, “During the past 3 months,did you have a severe headache or migraine?” Respondents were instructed to report painthat had lasted a whole day or more, and not to report fleeting or minor aches or pains.

Pain-related diseases and conditionsArthritis: Persons were classified as having arthritis if they responded positively to the NHISquestion, “Have you ever been told by a doctor or other health professional that you hadsome form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?” On theNHANES, the question asked only about arthritis.

Peripheral neuropathy (PN): For the 1999–2000, 2001–2002, and 2003–2004 NHANES surveys,participants aged 40 years and older received monofilament testing of foot sensation at threesites (plantar, first metatarsal head; plantar, fifth metatarsal head; and plantar, hallux) on thebottom of each foot (total of six sites). PN was defined as 1 or more insensate areas.

Symptomatic PN: Persons with PN were classified as symptomatic if they responded positivelyto either question, “During the past 3 months, have you had a painful sensation or tingling inyour hands or feet? Exclude normal foot aches from standing or walking for long periods” or“During the past 3 months, have you had numbness or loss of feeling in your feet, other thanfrom your feet falling asleep?”


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Diagnostic classification used in health care visit charts

Clinical classification codes from the International Classification of Diseases (ICD),9th Revision, Clinical Modification (ICD-9-CM)

Condition ICD-9-CM CodeDiabetic neuropathy 250.6Fibromyalgia 729.1Injury

Fracture 800-829Dislocation 830-839Sprains and strains 840-848Contusion/superficial 910-924Crush 925-929Burns 940-949

Joint pain 719.4Low back pain 724.2Shingles 53.9Severe headache or migraines 346, 784.0, 307.81

Health status indicatorsGeneral health status: Persons rated their health in response to the NHIS question, “Wouldyou say your health in general was excellent, very good, good, fair, or poor?”

Activity limitations: Persons were classified as having activity limitations if they respondedpositively to the NHIS question, “Are you now limited in any way in any of your usualactivities because of arthritis or joint symptoms?”

Unable to work: Persons were classified as being unable to work if they responded positivelyto the NHIS questions, “Does a physical, mental, or emotional problem NOW keep you fromworking at a job or business?”

Psychological distress: Psychological distress was ascertained on the NHIS with the K6instrument which asked persons to report, “During the past 30 days, how often did youfeel…so sad that nothing could cheer you up? Nervous? Restless or fidgety? Hopeless? Thateverything was an effort? And worthless?” Possible answers are: all of the time (4 points),most of the time (3 points), some of the time (2 points), a little of the time (1 point), andnone of the time (0 points) for a possible total of 0 to 24 points. 13 or more is used to defineserious psychological distress.

Reduced sleep: Persons were classified as having reduced daily sleep if they reported sleepingless than 6 hours in answer to the NHIS question, “On average, how many hours of sleep doyou get in a 24-hour period?”


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Other definitionsDiabetes: Persons were classified as having diabetes if they self-reported in the NHANESinterview having been told by a physician that they have diabetes.

Body mass index (BMI): BMI was calculated as weight in kilograms divided by the square ofheight in meters, based on the NHIS sample adult’s responses to survey questions regardingheight and weight.

• Normal weight: A person was classified as normal weight if his/her BMI was greater thanor equal to 18.5 and less than 25.0.

• Overweight: A person was classified as overweight if his/her BMI was greater than or equalto 25.0 and less than 30.0.

• Obese: A person was classified as obese if his/her BMI was greater than or equal to 30.0.

Drug dataPrescription drug use data: NHANES participants were asked if they had taken a prescriptiondrug in the past month. Those who answered “yes” were asked to show the interviewer themedication containers of all prescription drugs. For each drug reported, the interviewerrecorded the product’s complete name from the container. Prescription drugs were classifiedbased on the therapeutic classification scheme of Cerner Multum’s Lexicon. Analgesic drugswere identified with a code of 58.

Non-prescription and select non-narcotic prescription analgesic use: NHANES participants wereshown a hand card with a list of non-prescription and prescription non-narcotic analgesicsand asked, “Have you ever taken any of these prescription or over-the-counter pain relievermedications nearly every day for as long as a month?” If a participant answered affirmatively,they were asked to identify each product taken and whether they were currently taking theproduct daily or nearly every day. Frequent monthly analgesic users were defined as adultswho currently used a pain reliever from the hand card daily or nearly every day.

Drug mentions at office-based physician visits: For the NAMCS, physicians or their staffs wereinstructed to record all new or continued medications ordered, supplied, or administeredat the visit. This included prescription and nonprescription preparations, immunizations,desensitizing agents, and anesthetics. In this survey, recorded medications are referred to asdrug mentions. Visits with one or more drug mentions are termed “drug visits.” Drugs forthe 2006 survey are classified based on the therapeutic classification scheme of CernerMultum’s Lexicon: analgesic drugs = 58, antidepressants = 249, and anxiolytics, hypnotics,and sedatives = 67.


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The Burden of PainAmong Adultsin the United StatesFindings from the National Health and Nutrition Examination Survey,the National Health Care Surveys, and the National Health Interview Survey

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