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.
