not been shown to be effective in managing chronic non-specific low-back pain. myofascial release has been used in some cases of fibromyalgia, chronic low back pain, and tennis elbow but there is not enough evidence to support this as method of treatment. epidemiology chronic pain varies in different countries affecting anywhere from 8% to 55% of the population. it affects women at a higher rate than men, and chronic pain uses a large amount of healthcare resources around the globe. a large-scale telephone survey of 15 european countries and israel found that 19% of respondents over 18 years of age had suffered pain for more than 6 months, including the last month, and more than twice in the last week, with pain intensity of 5 or more for the last episode, on a scale of 1 (no pain) to 10 (worst imaginable). 4839 of these respondents with chronic pain were interviewed in-depth. sixty-six percent scored their pain intensity at moderate (5–7), and 34% at severe (8–10); 46% had constant pain, 56% intermittent; 49% had suffered pain for 2–15 years; and 21% had been diagnosed with depression due to the pain. sixty-one percent were unable or less able to work outside the home, 19% had lost a job, and 13% had changed jobs due to their pain. forty percent had inadequate pain management and less than 2% were seeing a pain management specialist. in the united states, chronic pain has been estimated to occur in approximately 35% of the population, with approximately 50 million americans experiencing partial or total disability as a consequence. according to the institute of medicine, there are about 116 million americans living with chronic pain, which suggests that approximately half of american adults have some chronic pain condition. the mayday fund estimate of 70 million americans with chronic pain is slightly more conservative. in an internet study, the prevalence of chronic pain in the united states was calculated to be 30.7% of the population: 34.3% for women and 26.7% for men. in canada it is estimated that approximately 1 in 5 canadians live with chronic pain and half of those people have lived with chronic pain for 10 years or longer. chronic pain in canada also occurs more and is more severe in women and canada's indigenous communities. outcomes sleep disturbance, and insomnia due to medication and illness symptoms are often experienced by those with chronic pain. these conditions can be difficult to treat due to the high potential of medication interactions, especially when the conditions are treated by different doctors. severe chronic pain is associated with increased risk of death over a ten-year period, particularly from heart disease and respiratory disease. several mechanisms have been proposed for this increase, such as an abnormal stress response in the body's endocrine system. additionally, chronic stress seems to affect risks to heart and lung (cardiovascular) health by increasing how quickly plaque can build up on artery walls (arteriosclerosis). however, further research is needed to clarify the relationship between severe chronic pain, stress and cardiovascular health. psychology personality two of the most frequent personality profiles found in people with chronic pain by the minnesota multiphasic personality inventory (mmpi) are the conversion v and the neurotic triad. the conversion v personality expresses exaggerated concern over body feelings, develops bodily symptoms in response to stress, and often fails to recognize their own emotional state, including depression. the neurotic triad personality also expresses exaggerated concern over body feelings and develops bodily symptoms in response to stress, but is demanding and complaining. some investigators have argued that it is this neuroticism that causes acute pain to turn chronic, but clinical evidence points the other way, to chronic pain causing neuroticism. when long term pain is relieved by therapeutic intervention, scores on the neurotic triad and anxiety fall, often to normal levels. self-esteem, often low in people with chronic pain, also shows improvement once pain has resolved. it has been suggested that catastrophizing might play a role in the experience of pain. pain catastrophizing is the tendency to describe a pain experience in more exaggerated terms than the average person, to think a great deal more about the pain when it occurs, or to feel more helpless about the experience. people who score highly on measures of catastrophization are likely to rate a pain experience as more intense than those who score low on such measures. it is often reasoned that the tendency to catastrophize causes the person to experience the pain as more intense. one suggestion is that catastrophizing influences pain perception through altering attention and anticipation, and heightening emotional responses to pain. however, at least some aspects of catastrophization may be the product of an intense pain experience, rather than its cause. that is, the more intense the pain feels to the person, the more likely they are to have thoughts about it that fit the definition of catastrophization. comorbidity with trauma individuals with posttraumatic stress disorder (ptsd) have a high comorbidity with chronic pain. patients with both ptsd and chronic pain report higher severity of pain than those who do not have a ptsd comorbidity. effect on cognition chronic pain's impact on cognition is an under-researched area, but several tentative conclusions have been published. most people with chronic pain complain of cognitive impairment, such as forgetfulness, difficulty with attention, and difficulty completing tasks. objective testing has found that people in chronic pain tend to experience impairment in attention, memory, mental flexibility, verbal ability, speed of response in a cognitive task, and speed in executing structured tasks. a review of studies in 2018 reports a relationship between people in chronic pain and abnormal results in test of memory, attention, and processing speed. social and personal impacts social support social support has important consequences for individuals with chronic pain. in particular, pain intensity, pain control, and resiliency to pain have been implicated as outcomes influenced by different levels and types of social support. much of this research has focused on emotional, instrumental, tangible and informational social support. people with persistent pain conditions tend to rely on their social support as a coping mechanism and therefore have better outcomes when they are a part of larger more supportive social networks. across a majority of studies investigated, there was a direct significant association between social activities or social support and pain. higher levels of pain were associated with a decrease in social activities, lower levels of social support, and reduced social functioning. racial disparities evidence exists for unconscious biases and negative stereotyping against racial minorities requesting pain treatment, although clinical decision making was not affected, according to one 2017 review. minorities may be denied diagnoses for pain and pain medications, and are more likely to go through substance abuse assessment, and are less likely to transfer for pain specialist referral. preliminary research showed that health providers might have less empathy for black patients and underestimated their pain levels, resulting in treatment delays. minorities may experience a language barrier, limiting the high level of engagement between the person with pain and health providers for treatment. perceptions of injustice similar to the damaging effects seen with catastrophizing, perceived injustice is thought to contribute to the severity and duration of chronic pain. pain-related injustice perception has been conceptualized as a cognitive appraisal reflecting the severity and irreparability of pain- or injury-related loss (e.g., "i just want my life back"), and externalizing blame and unfairness ("i am suffering because of someone else's negligence."). it has been suggested that understanding problems with top down processing/cognitive appraisals can be used to better understand and treat this problem. chronic pain and covid-19 covid-19 has disrupted the lives of many, leading to major physical, psychological and socioeconomic impacts in the general population. social distancing practices defining the response to the pandemic alter familiar patterns of social interaction, creating the conditions for what some psychologists are describing as a period of collective grief. individuals with chronic pain tend to embody an ambiguous status, at times expressing that their type of suffering places them between and outside of conventional medicine. with a large proportion of the global population enduring prolonged periods of social isolation and distress, one study found that people with chronic pain from covid-19 experienced more empathy towards their suffering during the pandemic. effect of chronic pain in the workplace in the workplace, chronic pain conditions are a significant problem for both the person with the condition and the organization; a problem only expected to increase in many countries due to an aging workforce. in light of this, it may be helpful for organizations to consider the social environment of their workplace, and how it may be working to ease or worsen chronic pain issues for employees. as an example of how the social environment can affect chronic pain, some research has found that high levels of socially prescribed perfectionism (perfectionism induced by external pressure from others, such as a supervisor) can interact with the guilt felt by a person with chronic pain, thereby increasing job tension, and decreasing job satisfaction. mobility and road safety impacts a 2022 systematic review found that chronic pain could increase crash risk among drivers. chronic pain drivers report experiencing difficulties with safety maneuvers, such as shoulder checking for blind spots, merging with traffic, turning corners, and reversing the vehicle.