High Impact Chronic Pain

Chronic pain is among the leading causes of disability and reduced quality of life in the United States and around the globe (Von Korff et al., 2016). The centrality of chronic pain’s deleterious functional impact has been emphasized in the recent operationalization of High-Impact Chronic Pain (HICP; Dahlhammer et al., 2018). HICP is defined as the presence of pain on at least half of days in the previous 3-6 months with substantial restriction of functional participation in work, social, and self-care activities (Duca et al., 2022).  The assessment of HICP using 2 questions on pain duration and pain impact has been included in the recommendations for a minimum data set by the NIH Task Force on chronic low back pain (Amtmann et al., 2015); similarly, VA recommendations for core measures include assessment of pain duration and pain impact (Kroenke et al., 2019).

Recent studies have noted that tens of millions of Americans suffer from HICP, with prevalence estimates ranging from 8% to 14% of the US population (Dahlhamer et al., 2018; Von Korff et al., 2016).  The assessment of HICP forms the basis for monitoring progress toward achieving the United States’ Healthy People 2020 and 2030 pain objectives to reduce the prevalence of adults living with pain and disability (Duca et al., 2022). HICP is assessed with several questions assessing the duration, frequency, and impact of chronic pain, as well as one question regarding the impact of pain on work (Von Korff et al., 2020). These questions have been shown to be well-accepted and easily completed by nearly 100% of respondents, to be responsive to changes in health status, and to predict long-term outcomes specific to pain (Duca et al., 2022). In the PMC3, those who report pain on most days for the past 3 months, and who report that pain limits their life or work activities, are considered to have HICP.