Antoinette L Spector, Dina Flores, David Aaby, Patricia Coe
These findings provide longitudinal evidence that life stressors are upstream, modifiable determinants of new-onset pain among adults 50 and older, as well as viable targets for public health prevention programs. Population-level implementation of social needs screening, combined with clinical and community-based support, offers a proactive strategy to prevent the transition from no pain to chronic pain. These results support a paradigm shift from reactive pain management toward salutogenic, prevention-oriented public health approaches that promote healthy aging and reduce downstream pharmaceutical dependence.
BACKGROUND: Chronic pain represents a pressing public health problem affecting more than one in five American adults. Yet, primary prevention efforts aimed at stopping pain before it begins remain substantially underutilized. Chronic life stressors (CLS)-including financial strain, personal health problems, and caregiving burdens-are upstream, modifiable psychosocial risk factors that may drive pain incidence in aging populations. Identifying and addressing these stressors at the population level offers a promising, non-pharmacological pathway for preventing new-onset pain.
METHODS: We used data from the 2018 and 2020 Health and Retirement Study (HRS), a nationally representative longitudinal study of U.S. adults aged 50 and older (N = 14,133). Among 2,622 individuals reporting no pain at baseline (2018), we examined the association between eight CLS domains and pain incidence in 2020 using unadjusted and adjusted logistic regression models, adjusting for gender, race/ethnicity, education, marital status, employment status, and self-rated health.
RESULTS: In unadjusted models, moderate-to-severe self-health problems (OR = 2.13, 95% CI: 1.63-2.79, p < 0.001), physical/mental health problems in a spouse or child (OR = 1.46, 95% CI: 1.11-1.93, p = 0.007), and financial strain (OR = 1.62, 95% CI: 1.16-2.27, p = 0.005) were significantly associated with pain incidence. In fully adjusted models, moderate-to-severe self-health problems remained significant (OR = 1.62, 95% CI: 1.20-2.19, p = 0.002), and cumulative CLS exposure predicted pain incidence (OR = 1.13, 95% CI: 1.05-1.23, p = 0.002), with each additional stressor increasing pain odds by 13%.
CONCLUSION: These findings provide longitudinal evidence that life stressors are upstream, modifiable determinants of new-onset pain among adults 50 and older, as well as viable targets for public health prevention programs. Population-level implementation of social needs screening, combined with clinical and community-based support, offers a proactive strategy to prevent the transition from no pain to chronic pain. These results support a paradigm shift from reactive pain management toward salutogenic, prevention-oriented public health approaches that promote healthy aging and reduce downstream pharmaceutical dependence.