Rural Cancer Survivors More Likely to Have Chronic Pain

By Crystal Lindell

Rural cancer survivors are more likely to have chronic pain after cancer treatment than those who live in urban areas. And as a rural resident myself, I’m not surprised.

The findings are from a new study published in JAMA, led by Hyojin Choi, PhD.

Choi and her colleagues at the University of Vermont looked at over 5,500 U.S. adults with a cancer diagnosis in the last 5 years. The patients were then categorized as rural or urban residents, based on the population of counties where they lived. 

The study found a pretty striking difference between rural and urban cancer patients. Specifically, the prevalence of chronic pain was 43% among rural cancer survivors, compared to 33.5% among urban survivors.

The authors say the results suggest an association between chronic pain and the availability of pain specialists, survivorship resources, and insurance challenges accessing pain care in rural counties.

“Policymakers and health systems should work to close this gap by increasing the availability of pain management resources for rural cancer survivors. Approaches could include innovative payment models for integrative medicine in rural areas or supporting rural clinician access to pain specialists,” Choi wrote.

While the suggestions are well-intentioned, I’m not sure how practical or effective they would be. “Innovative payment models” sounds like they want rural patients to borrow money to pay for their healthcare. That’s not a true solution.

As someone who lives in rural Illinois and who has chronic pain, albeit not from cancer, I have some other thoughts on all this.

First, I want to note that I actually did live in an urban area when I first developed chronic pain in 2013. Within six months though, I made the decision to move in with family members who were living in a rural area, and I’ve been here ever since.

While, at the time, I was hoping to gain some much-needed emotional support by moving in with the family, the decision was largely driven by finances. I could no longer work the long hours and multiple jobs that it took for me to afford living in a more expensive urban area.

So, I suspect that a large part of why urban cancer survivors fare better than rural ones is that the rural cost of living is so much cheaper and thus it attacks people who have less money overall. The study, in fact, found that rural cancer survivors were nearly twice as likely to have household incomes below the federal poverty level than their urban counterparts (12% vs. 6.9%). 

We all know that more money gives access to better treatment. Of course, that doesn’t mean my rural area doesn’t have rich people. We definitely have rich people out here. But the next hurdle is the complete lack of providers near us. 

I personally drive about two hours each way to see my primary care doctor, because I want to get care at a university hospital and that is the closest option. A lot of other people who live near me also make that drive to the same university hospital system for the same reason.

However, even if you have money, and you can get care that far from home, having to drive such a long distance severely limits your healthcare treatments. It means that if you need a treatment that is required weekly, it either massively disrupts your life, or you just end up not doing it.

The easiest and cheapest way to treat pain is to send in a prescription for pain medication. That may not be the best way to address the pain long-term, but alternative treatments like physical therapy and massage are more of a hassle when you have to drive long distances to get them.

It’s also a lot more common to minimize both appointments and even emergency room visits when you know that doing either will require a lengthy drive. I assume that those tendencies also could contribute to post-cancer chronic pain.

My hope is that advances in treatment and technology solutions like virtual appointments will eventually help close the gap between rural and urban patients. Nobody should have to endure chronic pain simply because of where they live, but that is often the case.