An estimated 51.6 million US adults experienced chronic pain in 2021.¹ Barriers to effective pain management include lack of patient education and clinician training about pain management, shortage of pain management specialists, unconscious bias and stigma, insurance reimbursement policies, and cost.^2–4 This study describes factors that may affect the delivery of pain care for adults with chronic pain including patient perceptions of clinicians providing care and access to/affordability of prescription medications.

We analyzed data from the National Center for Health Statistics Rapid Surveys System (Round 2—Oct–Nov 2023). Adults with chronic pain were defined as those self-reporting pain most days or every day in the past 3 months. We examined whether individuals are currently receiving medical care for chronic pain and whether they agree their provider treats them with respect, listens carefully, and asks their opinions or beliefs about their pain treatment. Responses were analyzed overall and by demographic characteristics. Additionally, cost barriers for prescription medications and ordering medications online without a prescription were examined. Analyses were conducted in SAS (9.4) with survey commands to account for the complex survey design. This study was exempt from Institutional Review Board review.

Among adults with chronic pain in 2023, 46.9% reported currently receiving medical care for their pain (Table 1). Receipt of medical care was more prevalent among adults ≥ 50 years old and females. Overall, 89.6% of adults receiving medical care for chronic pain reported their provider “usually” or “always” treated them with respect, 89.5% reported their provider listened carefully, and 69.5% reported their provider asked their opinions or beliefs about their pain treatment. Adults reporting their provider listened carefully to them was less prevalent among females and adults 35–49 years old; fewer females also reported their provider asked their opinions or beliefs about their pain treatment. Reporting their provider listened carefully to them and asked their opinions or beliefs about their pain treatment was less prevalent among adults in metropolitan areas compared to non-metropolitan areas. Adults with the lowest household incomes (< 200% of the federal poverty level) reported the lowest prevalence of their provider treating them with respect or listening carefully to them.

Skipping medication doses, taking less medication, delaying prescription fills, and not getting needed medication due to cost were more prevalent among adults with chronic pain compared to those without chronic pain who took prescription medications in the past 12 months (Fig. 1A). Overall, 27.9% of adults with chronic pain reported at least one cost barrier for prescription medications compared to 15.3% of adults without chronic pain. Among adults with chronic pain reporting a cost barrier for prescription medications, 6.8% ordered medications online without a prescription compared to 3.3% among adults reporting no cost barriers (Fig. 1B).

Among adults with chronic pain in 2023, 47% reported currently receiving medical care for their pain. While the majority of those receiving medical care reported their provider treated them with respect, listened carefully, and asked their opinions or beliefs about their pain treatment, disparities were observed by age, sex, urbanicity, and income. Improved patient-provider relationships among these populations may increase the effectiveness of pain management therapies. The CDC’s 2022 Clinical Practice Guideline can be used to help improve communication between clinicians and patients about pain management and promote shared decision-making.²

Over one-quarter of adults with chronic pain reported difficulty affording prescription medications and among them a higher percentage ordered medications online without a prescription; online pharmacies may increase risk of receiving counterfeit or substandard medications.⁵ Use of opioid and nonopioid prescriptions for pain differ by geographic and socioeconomic factors,^6,7 which may contribute to patients ordering medications from online pharmacies. Prescription medications remain an important tool for effective pain management and it is critical to address barriers posed by inadequate insurance, high costs, and accessibility.²

Limitations include generalizability only to noninstitutionalized civilian adults; potential recall bias; lack of longitudinal patient history; inadequate sample sizes to estimate prevalence for demographic characteristics including sexual orientation and gender identity; and self-reported chronic pain rather than diagnoses. Despite limitations, this study identifies opportunities to improve patient-provider interactions among populations receiving medical care for chronic pain and reduce barriers to prescription medications, which could improve the delivery of and satisfaction with pain care for adults with chronic pain.