Prevalence and correlates of “undiagnosed pain”—Evidence from the US national Medical Expenditure Panel Survey

Abstract There are no nationally representative studies examining both the frequency and correlates of “undiagnosed pain”—pain without a formal diagnosis. To identify the magnitude of this healthcare gap, we performed cross-sectional secondary analyses of the Medical Expenditure Panel Survey (MEPS), 2016-2019 data. The primary study outcome is “being undiagnosed”: the absence of diagnoses for pain-related conditions among participants reporting pain-related interference (PRI). Pain-related interference was established using the SF36 pain question embedded in MEPS, with 10,954 individuals reporting any PRI within 4 weeks of the interview and 4,902 individuals reporting at least moderate PRI. Participants with PRI were assigned as “being undiagnosed” if the following conditions were met: (1) the participant did not have medical records for any pain-related conditions in both the previous and current year of the interview and (2) did not report having any pain-related priority conditions from a list provided during the MEPS interviews. Among those reporting any PRI, about 21.1 million people (9.3%; 95% confidence interval [CI], 8.6%-10.0%) were without diagnoses for either primary pain conditions identified using MEPS clinical classification codes or conditions where pain would be a secondary symptom (eg, hypertension and immunity disorders). From multivariable logistic regression modeling, we determined that younger and middle-aged adults, males, racial and ethnic minority groups, foreign-born populations, people without insurance, and people with better perceived health are more likely to have their pain undiagnosed. Our findings underscore the need for improved access to care and better patient-provider communications in those suffering from underdiagnosed pain.