Opioids can cause a sort of all-over, neurological pain that gets overlaid on top of the original pain, said Eldon Tunks, a professor emeritus of psychiatry at McMaster University. Doctors in other countries are less quick to dispense opioids for pain, other than for major surgical procedures.

It’s all in our heads (sort of)

The NBER paper also found that Americans, especially those of low education levels, have been gradually growing less happy since the 1970s, according to the General Social Survey.

Happiness Among Different Educational Groups in the United States

David Blanchflower

The pain that Americans report might be very real, but psychological factors might be contributing to it. As I’ve previously written, depression changes how the body releases its own, endogenous, pain-relieving chemicals, and it tends to exacerbate the perception of pain.

“Unhappiness and pain complaints go together, and the pain complaints didn’t always come first,” said Mark Sullivan, a professor of psychiatry at the University of Washington. In the United States, freedom comes with expectations—and for some, disappointment, he added.

The use of opioids and hallucinogens increases during economic downturns, so some of these patterns could be cyclical: Working-class Americans lose their jobs, so they become unhappy, so they start using opioids, so they start to feel more sensitive to pain.

Carol Graham, a Brookings fellow and University of Maryland public-policy professor, makes a similar point in her recent book Happiness for All? She and her colleagues found that sadness, anger, worry, stress, and physical pain were all higher among the poor in the United States than among the rich.

That might seem strange, given that prestigious jobs can appear demanding and stressful. But Graham suggests it’s just the opposite: “Stress that is associated with daily struggles and circumstances beyond individuals’ control—as is more common for the poor—has more negative effects than that associated with goal achievement—as is more common for those with more means and education,” she writes.

Tunks also pointed out that a sense of losing control—“being abused, being in a subservient job, being in a country with a lot of people shooting each other,” as he put it—can lead to anxiety, which, in turn, amps up the likelihood of pain.

There lies, in this anxiety, yet another potential cause of Americans’ greater reporting of pain: the worry that something must be wrong, and the feeling that we’re not doing enough to treat it. Arthur Barsky, a Harvard psychiatry professor who researches hypochondria, says it’s uniquely American to think all sorts of aches and pains are treatable, rather than just being part of life. The thinking seems to be, “if we can transplant hearts, and do fetal surgeries, we ought to be able to cure those migraine headaches!” he said.