“Those who do not remember the past are condemned to repeat it.” [^]

Yong and colleagues [18] are congratulated on a clear presentation of 2019 National Health Interview Survey (NHIS) data examining the frequency, severity and disability related to chronic pain. However, much of their data simply confirm observations from prior research, while their Discussion lacks comparisons with this research and offers few new insights.

There are numerous prior nationally representative studies that offer a basis for comparison. In 1993, Eisenberg and colleagues [7] published a seminal article showing that massage therapy, chiropractic care, and mind-body approaches were the most commonly used therapies for chronic pain conditions such as back problems and arthritis. They confirmed these findings in a second survey [6]. Astin [1] found that chronic pain was the primary reason U.S. adults used complementary health approaches, with chiropractic and massage therapy used most frequently, while Paramore [13] found that back, neck and shoulder pain were the most frequent reasons for a visit to chiropractors, massage therapists and acupuncturists. Using data from the Medical Expenditure Panel Survey, Bausell et al. [4] found that massage therapy and herbal remedies were frequently used to treat/manage musculoskeletal disorders including arthritis and back pain. Beginning in 2002, the National Center for Complementary and Integrative Health developed questions on the use of complementary health approaches [17] that were included in multiple years of the NHIS. Data from these questions were used in a series of papers examining trends in the use of complementary health approaches [2,3,5] that concurred with the findings of Eisenberg et al.,[6,7] Astin,[1] Paramore [13] and Bausell et al. [4] - chronic musculoskeletal pain conditions are the top reason for use of complementary health approaches. Yong et al. [18] did not acknowledge any of these highly cited antecedent observations in their Introduction or Discussion, giving the impression that they were the first to identify associations between pain and the use of complementary health approaches. An examination of the full body of evidence is required for a complete understanding of any research question being explored. Yong et al. [18] would have better served readers by comparing and contrasting their findings to these earlier papers, and documenting whether/how these current analyses moved the field forward.

While, in their Introduction, Yong et al. [18] do cite several papers describing the prevalence of chronic pain among US adults [8,9,14], they do not compare these findings to their own. For instance, while Johannes et al. [9] reported that 30% of adults reported chronic pain, Yong et al. [18] and Pitcher et al. [14] found substantially lower prevalence, 20.4% and 18.4%, respectively. What might account for these differences across studies? Similar to Yong et al [18], Hardt et al.[8] reported the location of pain in those with nonminor chronic pain using nationally representative data from the National Health and Nutrition Examining Survey. Like Yong et al [18], Hardt et al [8] found the highest prevalence of pain in the back and the upper extremities, with substantially lower prevalence in the face/teeth. Yong et al. [18] also do not mention relevant publications using the same NHIS pain questions they used, with the types of data presented by Yong et al. [18] clearly overlapping these earlier papers [10,11,12,19]. For instance, Kennedy et al. 2014 [10], Nahin [11] and Zelaya et al. [19] all examined the NHIS question on the frequency of pain in the past 3 months; while Zelaya et al. [19] reported 20.4% prevalence of chronic pain (most or every day / 3 months) in the US adult population, Kennedy et al. [10] and Nahin [11] reported slightly less, 19.0% and 17.4% (Figure 1¹¹), respectively. Using the same disability measures as Yong et al. [18], Nahin [11,12] reported that as pain frequency and severity increased, there was a corresponding increase in the proportion of adults: 1) reporting a work limitation due to a health problem [11]; and 2) reporting difficulties participating in social activities [12]. Using a separate nationally representative survey, Portenoy et al. [15] found that 26% of those with chronic pain said their pain impacted their ability to socialize.

In sum, Yong et al. [18] have provided important confirmatory information regarding the prevalence of chronic pain among U.S. adults and the use of complementary health approaches. The lack of comparisons between their own work and highly cited prior studies of the U.S. population impedes comparison of their approach, results, and perspectives with the existing literature.