Purpose Rural health disadvantages are well-documented in previous literature, however research on rural-urban disparities in chronic pain outcomes is scarce. This paper fills this gap by examining pain prevalences and transitions across the rural-urban continuum (i.e., large central metro, large fringe metro, medium and small metro, and nonmetropolitan). Methods Based on the 2019-2020 National Health Interview Survey Longitudinal Cohort (NHIS-LC) data, we examined the disparities in pain prevalences and transitions among different pain states, including no pain, nonchronic pain, chronic pain and high-impact chronic pain (HICP), across the rural-urban continuum and by age, sex, race/ethnicity, and region. A test for linear trend was conducted to examine the significance of linear changes across the rural-urban continuum. Findings The findings reveal significant linear increases in the prevalence of chronic pain and HICP, as well as transitions from no pain to nonchronic pain and from nonchronic pain to more severe pain conditions, along the continuum from metropolitan to nonmetropolitan areas. Sub-group analyses indicate that rural-urban gaps are most pronounced among middle-aged (45-64) groups and non-Hispanic whites. Conclusions This study provides new evidence on rural-urban health disparities by focusing on pain, highlighting the urgent need to enhance healthcare services in remote and rural areas for effective pain prevention and management.

The authors have declared no competing interest.

This study did not receive any funding

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The study used publicly available data that were originally located at:https://www.cdc.gov/nchs/nhis/documentation/2020-nhis.html

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All data used in the present study are available publicly online at https://www.cdc.gov/nchs/nhis/documentation/2020-nhis.html All Stata code is available on request to the authors.