The making of an epidemic of pain

Abstract Chronic pain in the United States has increased rapidly in recent decades. Social scientists argue that increases in pain are tied to economic conditions, but how the two are related remains a mystery. We draw on 96 immersive interviews with disability recipients and community leaders in one county in Central Appalachia to advance the hypothesis that “social pain”—or the painful feelings resulting from social disconnection—is a critical link between economic decline and the geographic clustering of pain. In our focal county, we find evidence that social pain proceeds from the consequences of economic decline in the region: declining job opportunities, loss of social infrastructure, increasing overdose deaths, and natural disasters. We show how this social pain exacerbates existing impairments and furthers social isolation, thereby limiting the ability of residents to manage their physical pain. The results highlight how economic decline can create the conditions for widespread pain and how that pain, in turn, can exacerbate the underlying health conditions of entire communities.