Chronic life stressors and pain incidence in adults 50 and older: a longitudinal analysis with implications for pain prevention and public health promotion.

Background: Chronic pain represents a pressing public health problem affecting more than one in five American adults. Yet, primary prevention efforts aimed at stopping pain before it begins remain substantially underutilized. Chronic life stressors (CLS)-including financial strain, personal health problems, and caregiving burdens-are upstream, modifiable psychosocial risk factors that may drive pain incidence in aging populations. Identifying and addressing these stressors at the population level offers a promising, non-pharmacological pathway for preventing new-onset pain. Methods: We used data from the 2018 and 2020 Health and Retirement Study (HRS), a nationally representative longitudinal study of U.S. adults aged 50 and older ( Results: In unadjusted models, moderate-to-severe self-health problems (OR = 2.13, 95% CI: 1.63-2.79, Conclusion: These findings provide longitudinal evidence that life stressors are upstream, modifiable determinants of new-onset pain among adults 50 and older, as well as viable targets for public health prevention programs. Population-level implementation of social needs screening, combined with clinical and community-based support, offers a proactive strategy to prevent the transition from no pain to chronic pain. These results support a paradigm shift from reactive pain management toward salutogenic, prevention-oriented public health approaches that promote healthy aging and reduce downstream pharmaceutical dependence.