Key PointsQuestionWhat are the rates of chronic pain (pain “most days” or “every day”) and high-impact chronic pain (chronic pain that limits life or work activities on most days or every day) incidence and persistence in US adults?FindingsIn this cohort study of 10 415 adult participants in the National Health Interview Survey 2019-2020 Longitudinal Cohort, the incidence rates of chronic pain and high-impact chronic pain in 2020 were 52.4 cases per 1000 person-years (PY) and 12.0 cases per 1000 PY, respectively. Among adults with baseline chronic pain, the rate of persistent chronic pain was 462.0 cases per 1000 PY.MeaningThese longitudinal data emphasize the high disease burden of chronic pain in the US adult population and the need for early management of pain.