I’m Dr. Daniel Cameron. In my practice, I often see patients with chronic pain, and I want to explore whether chronic Lyme disease could be part of the puzzle behind America’s growing pain epidemic.

A recent paper by Jovkovich in Pain reported that chronic pain prevalence in U.S. adults rose from 21% in 2019 to 24% in 2023—affecting 60 million people. Only about 13% of this increase was linked to long COVID. The rest remains unexplained.

Overlap Between Lyme Pain and National Pain Trends

The types of pain described—back, neck, joint, headache, abdominal, and widespread musculoskeletal pain—mirror what I see in chronic Lyme patients. Lyme pain is often multi-system, migratory, unpredictable, and can flare with fatigue and stress. It includes:

Musculoskeletal pain: Joint and tendon pain, often misdiagnosed as fibromyalgia.

Neurologic pain: Headaches resistant to migraine therapy, burning or electrical-shock sensations, small fiber neuropathy.

Abdominal/pelvic pain: Frequently linked with autonomic dysfunction.

Why Lyme Gets Missed

Testing limitations: Standard CDC two-tier testing is more reliable in acute cases, leaving many chronic patients without positive results.

Mislabels: Fibromyalgia, chronic fatigue syndrome, or “pain of unknown origin.”

COVID-era factors: More outdoor exposure, missed diagnoses due to care delays, absent rash or visible tick bite.

Geography and Demographics

The pain hotspots in the Pain study—Northeast, Upper Midwest, Pacific coast—are also Lyme-endemic regions. Affected populations included working adults, outdoor enthusiasts, rural and suburban residents, aligning closely with Lyme risk groups.

Strongest Evidence: Treatment Response

Perhaps the clearest sign is clinical: when patients with undiagnosed Lyme receive targeted antibiotic or co-infection therapy, their chronic pain often improves or resolves.

Bottom line: Chronic Lyme disease may be an overlooked contributor to America’s pain crisis. The symptoms overlap, the geography matches, and patients often respond to treatment. To better address the 60 million Americans in pain, we need to update diagnostic strategies, look beyond tick rash and positive tests, and include Lyme disease in the differential.