Pain and Money: What's the Connection?

Financial security is good for human health, both psychological and physical. Having money, however, doesn't completely protect anyone against mental illness (two of the best memoirs about depression, William Styron's "Darkness Visible" and Andrew Solomon's "The Noonday Demon," were written by affluent men) or physical illness (one of the wealthiest men in the world, Steve Jobs, died at a young age of cancer). But not having to worry about money, most would agree, is beneficial.

I have never given much thought to the effects of financial security on pain or pain management, so I was intrigued by a new article written by three business school academicians on this subject.¹

[[{"type":"media","view_mode":"media_crop","fid":"48279","attributes":{"alt":"","class":"media-image media-image-right","height":"450","id":"media_crop_6279440614827","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5755","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 8px; float: right;","title":"©David Pereias /Shutterstock.com ","typeof":"foaf:Image","width":"314"}}]]The goal of the paper was to determine if there was a relationship between physical pain and economic insecurity and the authors sought evidence in several existing studies as well as conducting their own research.

Utilizing data from a 2008 survey of 33,720 US households they found that households in which both heads were unemployed spent 20% more on over-the-counter pain relievers than did households where at least one head was employed.

In another study, they found that people who were unemployed were more likely to be experiencing pain and that simply living in a state with a high unemployment rate appeared to increase the risk for pain.

The authors also performed their own study, on the effects of thinking about financial insecurity on pain tolerance in a group of undergraduate college students. To measure baseline pain tolerance, students were asked to put their hands into ice cold water and to hold them there as long as they could. They were then informed of the value of their college degrees in the job market with half told their degrees would protect them from financial problems and the other told their degrees would be of limited value and that they were likely to be unemployed or underemployed.

Both groups exhibited similar pain tolerance in the initial part of the experiment but after they were told the value of their degrees, there was a 25% reduction in pain tolerance in the group given the less optimistic picture while there was no change in tolerance in the second group.

The authors of the paper attribute the relationship between pain and financial security with feelings of loss of control among those who are financially insecure. A possible explanation for the increased use of analgesic medications, they believe, is the country’s current high level of financial instability. They highlight how important it is for healthcare providers to assess for the financial situations of their patients when managing chronic pain.

I do not dispute any of the findings, but I do feel the authors, none of whom are healthcare professionals let alone experienced in pain management, have oversimplified the relationship between pain and finances.

Financial insecurity can have marked impact on mental health especially with regard to depression and anxiety. And while there is a widespread misconception that both depressive and anxiety disorders are secondary to a comorbid pain condition, we have known for years that pain is a very common presenting symptom of both conditions. It is not surprising, then, that any circumstance that can affect mental health could also increase the chances that a person will experience pain.

Going back to the undergraduate study, it is likely that any stressful scenario presented to the students would have had an impact on pain tolerance at least as significant as the one they found. I’m not certain that the fact that the proposed stress was financial made that much difference.

[[{"type":"media","view_mode":"media_crop","fid":"48278","attributes":{"alt":"","class":"media-image media-image-right","height":"258","id":"media_crop_7775369530642","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5754","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 5px; float: right;","title":"©luxorphoto/Shutterstock.com","typeof":"foaf:Image","width":"389"}}]]

Potential confounders

Any discussion of the effects of unemployment, thus financial insecurity, on pain in this country needs to account for the impact of being on disability or workers’ compensation. Many people who obtain unemployment compensation through either system may feel it akin to winning the lottery. I know through my experience with many patients, though, that participation is generally stressful. Beyond that, if the reason a person is receiving either benefit is related to pain, it is understandable if if the complaints continue if resolution of the pain would mean an end to benefits and being "fully" unemployed.

Regarding the data from the 2008 survey that found an increased use of OTC medications in households facing financial challenges, this result may at least in part reflect the US healthcare system. The information was obtained before passage of the Affordable Care Act (ACA) so the ACA’s effect of providing medical insurance to many previously uninsured Americans is not included. Even with the ACA, many people remain uninsured or underinsured; large numbers face high deductibles and co-pays and still hesitate to seek medical care except in the most dire circumstances. It would seem that these people are much more likely to self-medicate with OTC analgesics for pain than to seek professional care.

Taking this scenario one step further, even those who do see a healthcare professional for pain may prefer medication (ie, OTC pain relievers) alone to spending time and money on modalities such as physical and occupational therapies and cognitive-behavior therapy (the last of which is particularly beneficial when pain has a psychological component.) For the many whose employers don't provide sick leave, seeking professional care can mean the double whammy of money out-of-pocket to pay for it and the loss of wages.

I do agree with the authors of this paper that it is of vital importance that healthcare professionals inquire about environmental stresses, including economic ones, experienced by patients complaining of pain. A primary goal of effective pain management is to improve function so awareness of all external parameters that may affect this goal is important. The strategy used to reach this goal may be very different for someone who is unemployed and without a job to return to after treatment than for someone who has a current or new job waiting as soon as they are able to perform it again.

Source

Chou EY, Parmar BL, Galinsky AD. Economic insecurity increases physical pain.Psychol Sci. 2016;27:443-454.