Chronic pain hits US rural residents hardest
Pain may explain higher opioid use in rural areas, UTA study finds
A new study from The University of Texas at Arlington reveals that people who live in rural areas are more likely to have chronic pain than those in urban settings. They’re also more likely to go from having no pain or occasional pain to chronic pain. The findings may help explain higher opioid prescription rates in rural communities and could guide future research into the root causes of this disparity.
“We already know about the rural-urban gap in mortality and life expectancy,” said Feinuo Sun, UT Arlington assistant professor of kinesiology and lead author of the study in The Journal of Rural Health. “But when you look at pain, especially chronic pain, it becomes clear that rural residents face additional burdens.”
Chronic pain has been previously linked to higher risks of disability and mortality and contributes to increased health care costs—an estimated $261 billion and $300 billion annually in the U.S. One key takeaway from Dr. Sun’s study is the importance of timely intervention for middle-aged adults in rural communities as they are among the most vulnerable to developing chronic pain.
“Without early intervention, it can have serious long-term consequences, including premature mortality,” Sun said. “That’s why targeted outreach and early pain management strategies are so important.”
In her research, Sun, who has expertise in demography and population health, uses national data and a spatial analysis approach—a way of mapping how factors like health care services, job types and regional economic conditions shape health outcomes depending on where people live. In a 2024 study she authored, she found that rural residents expect to live more years with chronic pain than suburban and urban residents.
Sun’s latest findings suggest the chronic pain disparities are not solely due to limited access to health care in rural communities. Rural residents are more likely to work physically demanding jobs and experience higher poverty rates, both of which contribute to chronic pain. Elevated pain levels, along with fewer treatment options, may help explain the heavier reliance on opioids in these communities.
Sun’s research seeks to distinguish the root causes for higher opioid demand in rural areas.
“The goal for future research is to understand the causes of these disparities and to examine how differences in pain treatment between rural and urban areas contribute to the overall pain gap,” she said.
About The University of Texas at Arlington (UTA)
Celebrating its 130th anniversary in 2025, The University of Texas at Arlington is a growing public research university in the heart of the thriving Dallas-Fort Worth metroplex. With a student body of over 41,000, UTA is the second-largest institution in the University of Texas System, offering more than 180 undergraduate and graduate degree programs. Recognized as a Carnegie R-1 university, UTA stands among the nation’s top 5% of institutions for research activity. UTA and its 280,000 alumni generate an annual economic impact of $28.8 billion for the state. The University has received the Innovation and Economic Prosperity designation from the Association of Public and Land Grant Universities and has earned recognition for its focus on student access and success, considered key drivers to economic growth and social progress for North Texas and beyond.
Journal
The Journal of Rural Health
Method of Research
News article
Subject of Research
People
Article Title
Development of chronic pain and high-impact chronic pain across the US rural–urban continuum, 2019–2020
Aquatic therapy can heal the muscles and minds of people with chronic low back pain
A Concordia study finds a link between spinal muscle morphology and pain-related fears, anxiety and sleep quality
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Maryse Fortin: “Aquatic therapy is an interesting medium to study people who have pain-related fear like kinesiophobia and pain catastrophizing, and how those relate to spinal musculature.”
view moreCredit: Concordia University
A new Concordia study suggests that aquatic therapy for individuals with chronic low back pain can do more than strengthen the muscles around the spine. It can also have a beneficial impact on the negative psychological factors that are often associated with the disabling disease.
The study used a randomized controlled trial involving two groups of chronic low back pain patients. It found that participants who took part in aquatic therapy reported improvements in pain-related fear and sleep disturbance compared to those who followed standard care programs.
The authors believe that this study shows preliminary evidence that links aquatic therapy with improved psychological outcomes for individuals with low back pain. Their findings were published in the Nature journal Scientific Reports.
“Getting into water makes people feel better right away, because it takes away loading on the spine,” says corresponding author Maryse Fortin, an associate professor in the Department of Health, Kinesiology and Applied Physiology.
“This made aquatic therapy an interesting medium to study people who have pain-related fear like kinesiophobia (the fear of movement stemming from a fear of pain or injury) and pain catastrophizing, and how those relate to spinal musculature.”
Stronger backs and healthier lives
The study looked at two groups of 17 participants (34 total) with chronic low back pain. They were randomly assigned to either an aquatic exercise program or to a standard treatment program for low back pain. Both were supervised by graduate students who are also certified athletic therapists, at Concordia’s SwimEx pool or the School of Health Athletic Therapy Centre.
Participants attended two sessions weekly for 10 weeks where they engaged either in a standard treatment (which included land-based exercises) or in a standardized aquatic therapy strengthening program focusing on exercises targeting the torso and hips. They also completed questionnaires about pain, disability, quality of life, pain-related fears, depression, anxiety and sleep quality.
All participants completed their questionnaires and underwent strength tests and MRI scanning before their first session and again after the last one following the 10-week program.
The aquatic therapy group showed significant increase in muscle size in the multifidus and the erector spinae in the upper spine, two sets of spinal muscles that are crucial to spinal stabilization. However, the increases were not noted in the lower lumbar spine, which is most subject to muscle fatty intrusions and degradation and is considered the most problematic area for people with low back pain.
Both the aquatic and standard care groups showed marked improvements in mean and maximum lumbar strength.
“Combined with the reduction in anxiety, pain-based fears and sleep disturbances, these make for really interesting findings, and we definitely need to look at that relationship more closely,” Fortin says. “The changes were clinically significant, not just statistically significant, meaning they have a true impact on how the participants feel.”
The study’s lead author is Brent Rosenstein, PhD 25. Co-authors include Chanelle Montpetit, Nicolas Vaillancourt, Geoffrey Dover, Christina Weiss, Lee Ann Papula and Antonys Melek.
The study received support from the Fonds de recherche du Québec - Santé and from the R. Howard Webster Foundation.
Read the cited paper: “Aquatic exercise versus standard care on paraspinal muscle morphology and function in chronic low back pain patients: a randomized controlled trial.”
Journal
Scientific Reports
Method of Research
Randomized controlled/clinical trial
Subject of Research
People
Article Title
Aquatic exercise versus standard care on paraspinal muscle morphology and function in chronic low back pain patients: a randomized controlled trial
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