Pain That Limits Daily Function Tied to Cost-Related Barriers to Care in U.S. Adults

Adults in the United States whose pain limits their daily functioning face substantially higher odds of going without needed medical care because of cost, according to an analysis of nationally representative survey data published in BMC Health Services Research. The study, led by Fares Qeadan and colleagues, found that pain-related functional limitation—with or without co-occurring tobacco or alcohol use—was associated with delayed care and an inability to afford medical care at the household level.

The researchers analyzed 2022 Medical Expenditure Panel Survey data covering 10,777 adults. Pain-related functional limitation was defined as pain limiting normal work “moderately,” “quite a bit,” or “extremely.” Substance use was defined as tobacco use “every day” or “some days” and/or alcohol use at least monthly. From these definitions the team built a four-level profile for each respondent: neither condition, pain only, substance use only, or both.

The distribution of these profiles revealed how commonly the exposures overlap in the general population. Overall, 42.6 percent of adults had neither pain-related limitation nor substance use, 8.9 percent had pain only, 42.0 percent had substance use only, and 6.6 percent had both. The authors note that pain that limits daily functioning often co-occurs with tobacco and alcohol use, but that population-level data on unmet treatment needs have been limited.

Using survey-weighted logistic regression, the team examined associations between the four profiles and three measures of unmet care. Two were household-level, cost-related measures: delayed medical care due to cost and inability to afford medical care. The third was a person-level measure: needing counseling or treatment but not getting it. Regression models used outcome-specific complete cases.

The results pointed clearly to the pain-only group. Compared with adults who had neither exposure, pain-only respondents had higher odds of reporting household-level delayed care due to cost, with an adjusted odds ratio of 1.99 (95 percent confidence interval 1.34 to 2.95), and of being unable to afford medical care, with an adjusted odds ratio of 2.52 (95 percent confidence interval 1.62 to 3.93). Respondents with both pain-related limitation and substance use also showed elevated odds on both measures: 1.78 (95 percent confidence interval 1.22 to 2.59) for delayed care and 2.81 (95 percent confidence interval 1.80 to 4.37) for inability to afford care.

Substance use alone told a different story. The tobacco and alcohol-use-only group was not associated with either household-level cost-related outcome. However, it was associated with the person-level measure of unmet mental health treatment, with an adjusted odds ratio of 1.44 (95 percent confidence interval 1.19 to 1.73). The co-occurring pain and substance use group was likewise associated with unmet counseling or treatment needs, at an adjusted odds ratio of 1.65 (95 percent confidence interval 1.20 to 2.26).

The study also compared the profiles directly against one another using adjusted pairwise contrasts. The co-occurring group had higher odds than the tobacco and alcohol-use-only group for household-level delayed care, at an adjusted odds ratio of 1.86 (95 percent confidence interval 1.25 to 2.76), and for inability to afford care, at an adjusted odds ratio of 3.26 (95 percent confidence interval 2.01 to 5.28). Yet the co-occurring group did not differ significantly from the pain-only group on either cost-related outcome.

That last finding carries much of the study’s interpretive weight. In the discussion, the authors state that pain-related functional limitation, with or without tobacco or alcohol use, was associated with household-level cost-related unmet care, while tobacco and alcohol-use-only and co-occurring profiles were associated with person-level unmet mental health treatment.

The authors caution that the analysis is cross-sectional and cannot establish that pain or substance use causes unmet care. They write that longitudinal studies are needed to clarify temporality and to evaluate strategies for improving access to pain and behavioral healthcare. Until such studies are available, the findings stand as an observational portrait of how pain-related functional limitation, substance use, and reported barriers to affording and obtaining care cluster together among U.S. adults in 2022.

Subject of Research: Associations between pain-related functional limitation, tobacco and alcohol use, and unmet healthcare needs in U.S. adults

Article Title: Co-occurring pain-related functional limitation and tobacco/alcohol use is associated with unmet care in U.S. adults

Article References: Qeadan, F., Faucher, A., & Thornquist, R. (2026). Co-occurring pain-related functional limitation and tobacco/alcohol use is associated with unmet care in U.S. adults. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15535-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15535-6

Keywords: pain-related functional limitation, tobacco use, alcohol use, unmet care, cost-related barriers, Medical Expenditure Panel Survey, mental health treatment, health services research, cross-sectional study, survey-weighted logistic regression, Co-occurring, pain-related