Chronic Pain Is Rising—Is Lyme Disease Being Missed?

A new study found that chronic pain among U.S. adults increased from 21% in 2019 to 24% in 2023—now affecting nearly 60 million people. :contentReference[oaicite:0]{index=0}

While about 13% of this increase has been attributed to long COVID, a large portion remains unexplained.

As a clinician treating tick-borne illness, I believe we may be overlooking an important contributor: chronic Lyme disease pain.

The Numbers Don’t Fully Explain the Problem

The study documented increases across multiple pain categories, including:

• Back and neck pain
• Joint and limb pain
• Headaches
• Abdominal pain

Even when accounting for demographics, socioeconomic factors, and long COVID, the rise in chronic pain could not be fully explained.

Clinical observation: this unexplained increase mirrors what many clinicians are seeing—patients with complex, multi-system pain that defies standard diagnoses.

Chronic Lyme Disease Pain: A Pattern That Fits

Chronic Lyme disease pain often presents in ways that closely match these national trends.

In clinical practice, patients frequently report:

• Musculoskeletal pain: migrating joint pain without clear inflammation
• Neurological pain: burning, tingling, or electric shock sensations
• Headaches: often resistant to standard migraine treatment
• Abdominal and pelvic pain: without a clear gastrointestinal cause

Clinical pattern: pain is often widespread, fluctuating, and difficult to localize.

The Diagnostic Gap

One of the biggest challenges is how easily this pattern is missed.

Patients often describe their symptoms as:

• “It moves around my body.”
• “Some days I’m fine, other days I can’t function.”
• “Stress or fatigue makes it worse.”
• “Nothing helps consistently.”

These descriptions don’t fit neatly into a single diagnosis.

As a result, patients are often labeled with fibromyalgia, chronic fatigue syndrome, or unexplained pain—while a possible infectious cause remains unrecognized.

Geographic and Demographic Clues

Regions with the highest Lyme disease rates—the Northeast, upper Midwest, and parts of the West Coast—are also areas where unexplained chronic pain is frequently reported.

Working-age adults who spend time outdoors appear in both groups.

This overlap raises an important question: are we missing Lyme disease in a subset of chronic pain patients?

The Pandemic Connection

The COVID-19 pandemic may have contributed to this trend:

• Increased outdoor activity → more tick exposure
• Delayed care → missed early Lyme diagnosis
• Immune stress → possible activation of underlying infections

This overlap suggests chronic Lyme disease pain may be part of the broader post-pandemic pain landscape.

Treatment Response Offers a Clue

Many patients with long-standing unexplained pain improve when Lyme disease and co-infections are identified and treated.

Clinical insight: response to treatment may help uncover an underlying infectious cause.

Implications for Healthcare

If chronic Lyme disease contributes to the pain epidemic, several changes are needed:

• Include tick exposure and symptom patterns in pain evaluations
• Recognize limitations of current Lyme testing
• Improve access to clinicians experienced in tick-borne disease

Clinical Takeaway

Chronic Lyme disease pain may be an underrecognized contributor to the rising burden of chronic pain.

When symptoms are widespread, fluctuating, and unexplained, Lyme disease should be part of the differential diagnosis.

Key question: Are we missing an infectious cause in patients labeled with “unexplained” chronic pain?

Have you experienced chronic Lyme disease pain or seen its impact on your patients? Share your story below.

Resources

• Chronic pain study (2019–2023)
• Autonomic dysfunction and pain in Lyme disease
• Neuropathic pain in Lyme disease
• CDC: Chronic symptoms and Lyme disease

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention