What doesn’t kill us, hurts us longer: a cross-sectional analysis of gun violence exposure and chronic pain in the United States

Gun violence exposure (GVE) has been widely studied for its mental health consequences, but its relationship with chronic pain remains understudied. The study’s objective was to determine the association between direct and indirect forms of gun violence exposure and multiple chronic pain outcomes among US adults using nationally representative data. The current study is a cross-sectional observational analysis using a probability-based, nationally representative online survey conducted in May 2024. A total of 12,822 individuals were invited to participate via the Ipsos KnowledgePanel; 8,657 completed informed consent (67.5% response rate), and 8,009 qualified for the final analytic sample (93% qualification rate). Sampling weights were used to reflect national distributions. Six types of GVE were assessed: being shot, being threatened with a firearm, hearing gunshots, witnessing a shooting, knowing a friend/family member who was shot, and knowing someone who died by firearm suicide. A cumulative exposure index (range: 0–6) was also constructed. Four binary pain outcomes were measured using adapted items from the Graded Chronic Pain Scale-Revised: (1) experiencing pain most days or every day, (2) reporting a lot of pain at last episode, (3) pain that limits work/life activities, and (4) pain that affects family or significant others. Weighted logistic regression models were used to estimate associations. Among 8,009 participants (mean age, 51.8 years; 51.0% female; 61.3% White, 12.1% Black, 17.5% Hispanic), 23.9% reported pain most/every day, and 18.8% reported a lot of pain. Being shot, threatened, or knowing someone who died by firearm suicide were consistently associated with multiple pain outcomes. Cumulative GVE was associated with higher odds of each pain outcome, including pain most/every day (OR, 1.32; 95% CI, 1.26–1.39) and pain limiting work/life activities (OR, 1.26; 95% CI, 1.17–1.36). Supplemental models suggest that exposure frequency is additionally associated with higher odds of pain outcomes. Gun violence exposure, experienced directly or indirectly, is associated with increased chronic pain in the U.S. adult population. These findings underscore the need to integrate pain assessment and management into trauma-informed care models and public health violence prevention strategies.