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Chronic Pain

The Surprising Connection Between Pain and Your Pocketbook

More than a fifth of citizens in rich nations suffer from chronic pain. Why?

Key points

  • The level of pain experienced by individuals in a society may mirror the trajectory of the unemployment rate, research suggests.
  • Upticks in pain during an economic downturn may affect women more than men.
  • Psychological stress during periods of unemployment may contribute, in part, to illness and physical pain.
Klara Kulikova / Unsplash
Source: Klara Kulikova / Unsplash

A new article forthcoming in the academic journal Social Science and Medicine finds a surprising connection between physical pain and the state of the economy. According to the researchers, the level of pain experienced by individuals in a society mirrors the trajectory of the unemployment rate — and that upticks in pain during an economic downturn affect women more than men.

“More than a quarter of the world's citizens are in physical pain,” say the researchers, led by Lucia Macchia of the Harvard Kennedy School. “It is thus one of the most important [phenomena] to understand.”

Up to this point, research on physical pain and economic cycles has been relatively sparse. One study examining back pain claim rates in the Canadian province of Ontario between 1975 and 1993 found no evidence that claims went up during a recession.

There are also reasons to expect pain to decrease during an economic downturn.

“People work longer hours in good times, so pain levels could be expected to track the economy in a pro-cyclical rather than anti-cyclical way,” say the authors. “A slower economy should, in principle, be easier on the human body.”

Some research, however, suggests there is truth to Macchia’s hypothesis — that physical pain is lower in a boom and greater in an economic downturn. For instance, a study in Sweden found that chronic pain levels were higher in areas with greater unemployment. A study in Japan found a similar result.

To test this, Macchia and her team used data from the Gallup World Poll, a nationally representative survey that contains data from more than 150 countries across a 15-year time period (2005–2018). Specifically, they examined participants’ responses to self-reported physical pain in relation to the unemployment rate.

They found self-reported physical pain to be higher when the unemployment rate was higher and lower when the unemployment rate was lower. They found this relationship to be more pronounced in rich countries and among women.

“Why women are so deeply affected by physical pain in recessions is a fundamental and pressing question,” say the researchers. “Potential explanations [...] include potential roles, in harsh economic times, for increased domestic abuse and violence, greater exploitation of vulnerable kinds of employees, physical injuries resulting from criminal activity, and physiological effects from the consumption of cheaper and less healthy kinds of food. Future research may be able to explore whether there is evidence for such pathways.”

The authors believe their research highlights the importance of psychological factors when it comes to understanding physical pain.

“One feasible, and perhaps plausible, way to account for this study’s patterns is that there is a link between mental stress and physical pain,” say the researchers. “Human beings who are anxious and under psychological strain may be intrinsically tense, and susceptible to illness, and thus they might report (and feel) greater physical pain.”


Macchia, Lucia. One Reason Why You May Be Experiencing More Pain Than Normal., 7 Oct. 2021.

Macchia, L., & Oswald, A. J. (2021). Physical pain, gender, and the state of the economy in 146 nations. Social Science & Medicine, 287, 114332.

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