The Economy of Pain

• In Event: Poverty

Abstract

Chronic pain is increasing among Americans, with nearly one-in-five American adults experiencing pain most days. However, the treatment of pain varies significantly with location. This paper uses the concept of “transfer economy” to explore local variations in how pain is treated. Economists often divide industries into “basic” and “non-basic” sectors depending on whether they bring money into a region from outside or serve local demand. Most scholars have focused on export industries as the central engine of regional economies. However, transfer income – payments to individuals from national or state governments – is another option. While transfer payments target people, not places, studies from the United States and other countries suggest the programs have various geographic impact as well. This paper, drawing on 178 interviews, argues that an economy of pain has emerged in Eastern Kentucky, where the “non-basic” sector is sustained by the illness of residents. This paper shows how healthcare facilities – including pharmacies, primary care doctors, pain management clinics, addiction treatment centers – have proliferated in Eastern Kentucky, partially due to how Medicaid has been administered. Second, this paper extends the focus to Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) and the local impact they have had. By focusing on disability assistance, this paper widens the scope of pain management infrastructure, going beyond just healthcare institutions (that receive Medicaid and Medicare) to show how a wider range of actors in the community are involved in the managing of residents’ pain.

Authors

• Christine Jang-Trettien, CUNY

• Kathryn J. Edin, Princeton University

• Timothy J Nelson, Princeton University

• Daniel Bolger, Southern Methodist University