One in four American adults lives with chronic pain — and a growing share of them are doing something that makes it significantly worse: hiding it at work.
A new study published in the Academy of Management Journal offers a window into why so many workers with chronic pain end up in worse shape than when they started, and why the workplace itself — not just the underlying condition — is often what pushes people out of their jobs. The research, conducted by management scholars from Creighton University and Boston College alongside two colleagues, draws on in-depth interviews with 66 U.S. workers conducted between 2019 and 2021. What they found cuts to something most workplace health conversations miss entirely.
The Numbers Behind the Pain
Chronic pain — defined as pain lasting at least three months — affected roughly 23% of U.S. adults in 2023, up from 19% in 2019. That four-percentage-point jump in just four years represents millions of additional people navigating daily discomfort while trying to remain productive. The economic toll is staggering: an estimated $722 billion in lost productivity annually, according to research published in Medical Care.
But those figures only tell part of the story. They capture the output side of the problem. What's harder to quantify is the human cost of how workers respond to pain when they feel they have no choice but to push through it — and how that response often accelerates the very decline employers are trying to prevent.
The "Ideal Worker Body" Problem
The study introduces a concept that deserves wider recognition in HR and management circles: the pressure to maintain an "ideal worker body." Across a professionally diverse sample — lawyers, grocery workers, teachers, police officers, healthcare professionals — researchers found a strikingly uniform response to chronic pain. Workers felt compelled to appear physically capable, regardless of what was happening inside their bodies.
This wasn't just about optics. It was a deeply internalized pressure. Participants described taking the stairs instead of the elevator to seem like everyone else. They avoided applying ice packs or stretching in view of colleagues. They sat through meetings without shifting positions, despite worsening pain. The performance of physical normalcy had become as much a part of their job as the job itself.
The cruel irony is that all 66 participants reported that these concealment behaviors made their pain worse. By suppressing visible pain management — the things that actually help — they were trading short-term social comfort for long-term physical deterioration. Most eventually reached a breaking point where functioning at work became impossible. Some found new roles more compatible with their condition. Others left the workforce entirely.
This tracks with broader data: chronic pain is the leading reason workers become eligible for long-term disability benefits. The study suggests that workplace culture may be quietly accelerating that process.
Why This Matters Beyond Healthcare Policy
The typical framing of chronic pain in workplace discussions centers on accommodation, insurance, and disability law. Those are real and important issues. But this research highlights a more upstream problem — one rooted in cultural expectations that most managers never consciously articulate but that workers absorb nonetheless.
The "ideal worker" concept has a long academic history. It originally described the expectation that committed employees subordinate personal obligations — family, health, other life demands — to work. Previous research has linked these expectations to mental health damage. This study extends that finding to physical health, showing that the same pressure operates on bodies, not just schedules.
The sample skewed heavily female (78%), reflecting both the higher prevalence of chronic pain among women and their greater willingness to discuss it in research settings. But the researchers were careful to note that the dynamics they identified — shame, concealment, worsening symptoms — appeared across genders, job types, and income levels. This isn't a problem confined to any single demographic.
What Actually Helps
A minority of participants managed to break the cycle, and their experiences point toward concrete interventions — both individual and organizational.
The first factor was medical validation. Workers who received a clear diagnosis and had a physician explicitly acknowledge their physical limitations were released from the psychological pressure to perform capability they didn't have. This sounds straightforward, but chronic pain conditions like fibromyalgia and migraines are notoriously difficult to diagnose and are frequently dismissed by healthcare providers. The validation itself — "your pain is real, and your body cannot do what it once could" — turned out to be therapeutically significant.
The second factor was employer orientation. Workers who recovered their footing tended to have managers and organizations focused on output rather than physical presentation. This shift in focus — from how a worker's body looks and moves to what the worker actually produces — created room for adaptation. Participants described asking colleagues for help without shame, stretching during meetings, using dictation software instead of typing, and turning off cameras during video calls to lie down during back flare-ups.
The creativity these workers brought to their own adaptations is striking. An ultrasound technician learned to alternate arms during patient scans rather than overloading one side. A deli worker started using a cart for heavy items. These aren't dramatic accommodations — they're small behavioral shifts that required only one thing: permission. Not formal legal accommodation, but social permission to manage their bodies without shame.
The Practical Takeaway for Managers and Workers
For managers, the research is a useful check on an assumption that often goes unexamined: that a productive employee is one who appears physically capable and present in the traditional sense. The data suggests this assumption is not only inaccurate but actively harmful. Workers who feel free to manage their pain — visibly, practically, without apology — stay in their roles longer and perform better than those who conceal it.
Creating that environment doesn't necessarily require formal policy changes, though accommodations matter. It starts with how pain and physical limitation are discussed — or not discussed — in team settings. A manager who normalizes breaks, visible pain management, and flexible working positions sends a different signal than one who prizes stoic presence.
For workers with chronic pain, the study's findings offer something worth sitting with: the concealment behaviors that feel socially protective are likely making the underlying condition worse. The short-term cost of being seen managing pain — a colleague's glance, a minor awkwardness — is almost certainly lower than the long-term cost of not managing it.
The researchers note that these dynamics extend beyond workers with diagnosed chronic conditions. Anyone in a professional or public setting can feel pressure to conceal physical discomfort, and failing to respond to the body's signals — whether by moving, stretching, or resting — creates vulnerability to accumulated pain over time. The "ideal worker body" expectation doesn't just harm people who already hurt. It shapes the physical habits of everyone trying to meet it.
As remote and hybrid work arrangements continue to reshape how and where people work, employers have a genuine structural opportunity here. The camera-off Zoom call, the flexible desk setup, the asynchronous meeting — these aren't just productivity tools. For workers managing chronic conditions, they can be the difference between staying in the workforce and leaving it. Whether organizations recognize that potential may say more about workplace culture than any formal wellness program ever could.