There is an expectation that, on average, pain will increase with age, through accumulated injury, physical wear and tear, and an increasing burden of disease. Consistent with that expectation, pain rises with age into old age in other wealthy countries. However, in America today, the elderly report less pain than those in midlife. This is the mystery of American pain. Using multiple datasets and definitions of pain, we show today’s midlife Americans have had more pain throughout adulthood than did today’s elderly. Disaggregating the cross-section of ages by year of birth and completion of a bachelor’s degree, we find, for those with less education, that each successive birth cohort has a higher prevalence of pain at each age—a result not found for those with a bachelor’s degree. Thus, the gap in pain between the more and less educated has widened in each successive birth cohort. The increase seen across birth cohorts cannot be explained by changes in occupation or levels of obesity for the less educated, but fits a more general pattern seen in the ongoing erosion of working-class life for those born after 1950. If these patterns continue, pain prevalence will continue to increase for all adults; importantly, tomorrow’s elderly will be sicker than today’s elderly, with potentially serious implications for healthcare.

预计平均而言，疼痛会随着年龄的增长而增加，这是由于累积的伤害，身体磨损和疾病负担增加所致。与这种期望一致，在其他富裕国家，痛苦随着年龄的增长而上升。但是，在当今的美国，老年人的痛苦要比中年人的痛苦少。这是美国人痛苦的奥秘。使用多个数据集和疼痛定义，我们显示当今的中年美国人在成年后比今天的老年人遭受更多的痛苦。通过按出生年份和学士学位的完成程度对年龄的各个部分进行分类，我们发现，对于那些受教育程度较低的人来说，每个连续的出生队列在每个年龄段的疼痛患病率都较高，而对于那些年龄较大，学士学位。从而，在每个连续的出生队列中，受过高等教育的人之间的疼痛鸿沟在扩大。出生队列中所见的增加不能用教育程度较低的人的职业或肥胖水平的变化来解释，但可以适应从1950年以后出生的工人阶级生活的持续侵蚀所看到的更普遍的模式。如果这些模式继续下去，就会感到痛苦所有成年人的患病率将继续增加；重要的是，明天的老人会比今天的老人病重，这可能会对医疗保健产生严重影响。所有成年人的疼痛发生率将继续增加；重要的是，明天的老人会比今天的老人病重，这可能会对医疗保健产生严重影响。所有成年人的疼痛发生率将继续增加；重要的是，明天的老人会比今天的老人病重，这可能会对医疗保健产生严重影响。