Pain treatment spending spans direct medical care, medicines, therapy, disability and lost productivity. In the United States, estimates range from historical pain-attributable costs based on 2008 data to a 2021 chronic-pain burden estimate, while 2024 national payer figures provide broader spending context rather than pain-specific totals.
Key Pain Treatment Spending Statistics
The most useful headline measures are:
- In 2016, 20.4% of U.S. adults had chronic pain, defined as pain on most days or every day during the previous three months.
- In 2016, 8.0% of U.S. adults had high-impact chronic pain, meaning chronic pain limited life or work activities on most days or every day.
- A 2018 report cited $560 billion annually in direct medical costs, lost productivity and disability programs associated with pain in the United States.
- The 2010 National Academies estimate put total annual pain cost at $560–$635 billion in 2010 dollars, using 2008 MEPS data.
- The National Academies estimate put direct annual pain-related health-care costs at $261–$300 billion in 2010 dollars.
- In 2021, medical-care costs associated with chronic pain were estimated at $530.6 billion in the United States.
- In 2021, lost work productivity associated with chronic pain was estimated at $192.2 billion in the United States.
- The estimated total 2021 economic cost of chronic pain was $722.8 billion.
- In 2021, adults with chronic pain had $8,068 in additional annual medical expenditures per person compared with adults without chronic pain.
- In 2024, U.S. national health expenditures totaled $5.3 trillion, covering all conditions rather than pain specifically.
- In 2024, out-of-pocket health spending reached $556.6 billion, or 11% of national health expenditures.
- From 2000 to 2022, physical-therapy procedure utilization per 1,000 Medicare beneficiaries increased 284%.
- From 2000 to 2022, spinal-manipulation utilization per 1,000 Medicare beneficiaries decreased 45%.
- In the two years after Medicare coverage began in January 2020, acupuncture utilization increased 176% per 1,000 Medicare beneficiaries.
- In 2020, Medicare oxycodone prescriptions cost more than $558 million.
- In a 2007–2011 managed-care cohort, 93% of 257,602 analytic opioid patients had short-term use.
- Among chronic opioid users in that cohort, mean all-cause medical costs rose from $11,430 to $27,365 per patient in the first six months after initiation.
- In a primary-care chronic-pain cohort, 19.7% of participants were hospitalized for any cause during one year.
Contents
- Key Pain Treatment Spending Statistics
- National pain treatment spending statistics and chronic-pain trends
- Medical-care spending and productivity losses
- Who pays for pain care: Medicare, Medicaid, insurance and out-of-pocket spending
- Nonpharmacologic pain-treatment utilization and spending
- Opioid treatment costs and related economic burden
- Patient-level pain-care costs, service use and program evidence
National pain treatment spending statistics and chronic-pain trends
The prevalence measures establish the population exposed to pain-related care needs. The CDC’s 2016 National Health Interview Survey estimates used self-reported definitions, so they describe reported experience rather than claims-defined treatment use.
| Measure | Period and population | Result |
|---|---|---|
| Chronic pain | 2016, U.S. adults | 20.4% |
| High-impact chronic pain | 2016, U.S. adults | 8.0% |
| Chronic-pain respondents | 2021, weighted MEPS analysis | 6,445 respondents representing 65.8 million adults |
| Medical-care cost | 2021, U.S. chronic-pain population | $530.6 billion |
| Lost productivity | 2021, U.S. chronic-pain population | $192.2 billion |
| Total economic cost | 2021, U.S. chronic-pain population | $722.8 billion |
The CDC defines chronic pain as pain on most days or every day in the previous three months, and high-impact chronic pain as chronic pain limiting life or work activities on most days or every day. CDC, Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016
The 2021 study estimated $8,068 in additional annual medical expenditures per person and $2,923 in additional annual lost productivity per person for adults with chronic pain versus adults without chronic pain. These are adjusted excess-cost estimates, not bills paid by every patient. Economic Costs of Chronic Pain—United States, 2021
Medical-care spending and productivity losses from pain
Older estimates remain useful for showing how pain costs were divided, but they are not inflation-updated current spending. The National Academies analysis used 2008 MEPS data and expressed results in 2010 dollars.
| Cost component | Annual estimate | What it measures |
|---|---|---|
| Total pain cost | $560–$635 billion | Health care plus productivity |
| Direct health-care cost | $261–$300 billion | Pain-attributable medical costs |
| Lost productivity | $299–$335 billion | Indirect productivity cost |
| Missed workdays | $11.6–$12.7 billion | Productivity component |
| Missed work hours | $95.2–$96.5 billion | Productivity component |
| Lower wages | $190.6–$226.3 billion | Productivity component |
The same analysis reported baseline annual health-care cost of about $4,250 for people without pain and an estimated $261–$300 in added annual health-care cost per person. Its cross-condition comparison put total pain cost above estimates for heart disease at $309 billion, cancer at $243 billion and diabetes at $188 billion; these comparisons combine different disease-burden estimates and do not represent treatment spending alone. The Economic Costs of Pain in the United States – Relieving Pain in America
Medicare was estimated to bear about one-fourth of U.S. medical expenditures for pain, equal to at least $65.3 billion in 2008. This is a historical National Academies estimate, not current Medicare pain spending. The Economic Costs of Pain in the United States – Relieving Pain in America
Who pays for pain care: Medicare, Medicaid, insurance and out-of-pocket spending
CMS payer totals show the scale of the U.S. health system surrounding pain care, but none of these figures isolates pain treatment. In 2024, national health expenditures were $5.3 trillion, or $15,474 per person, and equaled 18.0% of U.S. GDP.
| 2024 payer category | Spending | Share or change |
|---|---|---|
| Medicare | $1,118.0 billion | 21% of NHE |
| Medicaid | $931.7 billion | 18% of NHE |
| Private health insurance | $1,644.6 billion | 31% of NHE |
| Out of pocket | $556.6 billion | 11% of NHE |
| Other third-party payers, programs and public health | $590.5 billion | Down 7.0% year over year |
These totals include all medical conditions and services. They are therefore context for the payment environment, not a distribution of pain-specific spending by payer. CMS, NHE Fact Sheet
Nonpharmacologic pain-treatment utilization and spending trends
Medicare Part B enrollment rose from 37.3 million in 2000 to 59.5 million in 2022. The associated claims study measured billed procedures per 1,000 beneficiaries, not all users of pain care or every form of nonpharmacologic treatment.
- Physical-therapy procedure utilization per 1,000 Medicare beneficiaries increased 284% from 2000 to 2022.
- Spinal-manipulation utilization per 1,000 Medicare beneficiaries decreased 45% over 2000–2022.
- Osteopathic-manipulation utilization per 1,000 Medicare beneficiaries decreased 49% over 2000–2022.
- Acupuncture utilization increased 176% in the two years after Medicare coverage began in January 2020.
The study’s physical-therapy category included procedures such as therapeutic exercise, neuromuscular re-education, massage therapy and manual therapy. It did not measure every form of nonpharmacologic pain care, and the short post-coverage acupuncture period overlapped with pandemic-era changes in other service categories. Trends in Utilization and Cost of Nonpharmacological Pain Therapies in the United States Under Medicare Part B, 2000–2022
In 2020, Medicare oxycodone prescriptions cost more than $558 million. That amount exceeded payments for spinal manipulation, osteopathic manipulation and acupuncture combined by 19% within the study’s reported procedure-payment categories, so it is not a comparison of all opioid and all nonpharmacologic spending. Trends in Utilization and Cost of Nonpharmacological Pain Therapies in the United States Under Medicare Part B, 2000–2022
Opioid treatment costs and related economic burden
A retrospective managed-care study followed adults initiating opioids for non-cancer pain during 2007–2011. Of 2.9 million adults initiating opioids, 257,602 had at least 30 days of continuous use and entered the analytic cohort.
| Analytic-cohort measure | Patients or share | Definition or period |
|---|---|---|
| Short-term use | 239,998; 93% | 30–182 days |
| Chronic use | 17,604; 7% | At least 183 days |
| Weak opioid as index opioid | 215,424; 84% | Study potency category |
| Strong opioid as index opioid | 44,712; 17% | Study potency category |
Among chronic users, mean pharmacy costs rose from $2,029 at baseline to $4,331 in the first six months after initiation. Mean all-cause medical costs rose from $11,430 to $27,365 per patient over the same comparison, but the retrospective association does not prove that initiation caused every cost change. Treatment patterns, healthcare utilization, and costs of chronic opioid treatment for non-cancer pain in the United States
Separate CDC evidence-appendix estimates put annual direct and indirect costs of nonmedical prescription-opioid use at $53.4 billion, prescription-opioid abuse, dependence and misuse at $55.7 billion, and opioid-related overdose at $20.4 billion. These are substance-related economic burdens, not ordinary pain-treatment spending. CDC, Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016
Patient-level pain-care costs, service use and program evidence
Patient-level studies show how pain care can involve multiple settings and professional types. Their results should not be treated as national utilization rates because they come from defined clinical cohorts.
In a primary-care cohort of patients with moderate-to-severe chronic pain, 19.7% were hospitalized for any cause during one year, including 8.9% hospitalized for a possibly pain-related cause. Participants averaged 1.9 hospital days, 0.9 emergency-room visits, 4.8 primary-care visits and 2.1 specialist visits during the year.
At least one nonphysician health-professional visit was reported by 56.1% of participants. The cohort averaged 74.6 nonphysician visits per participant, including 40.3 physiotherapist visits and 13.5 massage-therapist visits; the study notes substantial variation and includes multiple professional types. Costs of moderate to severe chronic pain in primary care patients – a study of the ACCORD Program
A separate pediatric interdisciplinary pain-clinic cost analysis included 191 consecutively enrolled Medi-Cal/Medicaid patients receiving care in a U.S. clinic. Its design covered one year before and after clinic enrollment and was a single-clinic retrospective billing analysis, so it describes that pediatric Medicaid population rather than national pain spending. A Cost-Analysis of an Interdisciplinary Pediatric Chronic Pain Clinic