Rural Americans more likely to live with chronic pain than urban peers, UT-Arlington study finds

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ODESSA — Rural Americans are likelier to develop chronic pain than their urban counterparts, a grim trend exacerbated by limited access to health care, age and economic status.

A study conducted by the University of Texas at Arlington, released last week, found that more than a third of people in rural areas experience increased pain or are nearing a chronic pain diagnosis. Residents in urban areas, meanwhile, aren't as vulnerable to persistent, years-long pain and are likelier to experience no pain at all.

The peer-reviewed study was published in the Journal of Rural Health.

About 3 million Texans live in the state’s 200 rural counties. More people call rural Texas home than states such as Kansas, Mississippi and New Mexico.

As many as 100,000 rural Texans don’t have a primary care doctor, according to Texas 2036, an Austin-based think tank. Having a primary care doctor can help people identify chronic issues when they arise and make treatment options available.

“Due to health care shortages, limited access, and lower quality services, pain coping and management may be insufficient and less effective in rural areas, exacerbating the burden of pain,” the study’s authors wrote.

John Henderson, president and CEO of the Texas Organization of Rural and Community Hospitals, representing 157 hospitals in the state, was not surprised at the report’s conclusions.

Henderson said rural Texans often work physically demanding jobs where they are more prone to developing ailments, such as farming, ranching and oil field work. And in those areas, access to a healthcare facility or a primary care provider is limited. He said the distance to a hospital can take at least an hour, a drive many won’t make.

“If you’ve got to travel an hour to get the care you need in some of these poor, marginalized communities, they just don’t have a way to do that,” Henderson said.

The study relied on about 10,400 respondents, which the Centers for Disease Control and Prevention gathered in 2019. The respondents were asked to describe different thresholds of pain, from none at all to severe chronic pain. In 2020, the respondents were asked about how their pain progressed. The study sampled individuals from the age of 18 to those older than 65.

The 2025 findings exclude anyone who died, had missing contact information on the original study, was living under the care of a facility, or used someone else to communicate. Researchers used federal definitions of urban and rural, dividing them into four groups: from large metropolitan areas with more than a million residents to rural communities in towns with fewer than 5,000.

Chronic pain lasts at least three months, said Feinuo Sun, an assistant professor of kinesiology and the report’s lead author. Oftentimes, Sun said, it is associated with another disease, or a symptom of it. The study looks at chronic pain as a standalone and self-reported condition.

Between 2019 and 2020, most rural Americans’ pain either worsened or became chronic. More than a third of Americans aged 18-44 experienced an increase in pain. Nearly half of those in the 45 and older age group said the same. Men’s health in southern U.S. states between the ages of 45-64 had deteriorated the most, according to the study. Less than a third of Americans over 45 in rural areas recovered.

Urban residents reported a less pronounced progression of pain, while more of them recovered. People in rural areas “fare worse over one year compared to those in urban areas,” the report found.

The study’s methods were limited, the authors said. For instance, they relied on the pain the respondents reported without accounting for underlying causes, specific locations, or the duration of the pain. The authors also said the transition to severe pain could have been underestimated. The study did not sample as many racial and ethnic minorities, researchers added, noting that this made the findings for those groups less reliable.

Sun said the developing trend of pain in rural America results in people seeking prescribed opioids, or pain-relieving medications, which could lead to addiction and, at worst, death.

“Pain is consequential,” she said.

Disclosure: Texas 2036 and University of Texas - Arlington have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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