The Impact of Pain Reduction on Productivity and Cognitive Function in a Low-Income Population

Physical pain is a common but largely overlooked and poorly understood aspect of the lives of the poor. With frequent involvement in hard physical labor, uncomfortable living conditions, and limited access to adequate medical care, the poor are particularly likely to experience pain (Poleshuk and Green 2008; Johnson et al. 2013, Tsang et al. 2008). This heavy burden of physical pain is likely to be exacerbated in the coming years as pain increases with age and populations are aging rapidly around the globe (Loeser and Melzack 1999; McBeth and Jones 2007). As a consequence, more fully understanding the role of pain in the lives of the poor is both crucial and timely.
Physical pain may have significant and widespread impacts on individuals’ lives via a number of channels. Not only does pain directly reduce life quality and happiness, it may also lower productivity and earnings and hamper cognitive function and decision-making. Workers with chronic pain may work fewer days, take longer breaks, and make less-considered choices regarding healthcare decisions, reducing output and leading to greater impoverishment. However, despite the potential importance of chronic physical pain both in public health and economic terms, pain has been largely neglected in existing academic studies and policy-making, with potentially significant implications for millions of lives.
The proposed seed project will take the first steps in understanding the broader causal impact of physical pain on the lives of the poor via a randomized controlled trial (RCT). 450 low-income women in Chennai, India will be randomly assigned to one of three treatment arms: 600 mg of ibuprofen, a placebo pill, or no medication (pure control). All participants will complete detailed background surveys to gather demographic and health information and will complete a task to provide an objective measure of their pain. Both prior to and following the treatment, participants will engage in a task identical to their everyday work to measure their economic productivity and will complete a battery of standard, validated cognitive tasks (e.g. N-back, PVT, Hearts and Flowers, Corsi block-span) to measure cognitive function. Results from the study will be combined with the with the results from the 50,000-person Longitudinal Study of Aging in India (LASI) to improve our understanding of the potential for pain to impact the lives of the poor in urban India more broadly.
This study will benefit from the infrastructure provided by the PIs’ lab in Chennai, as well as a close collaboration with the Institute for Financial Management and Research (IFMR), a non-profit institute in Chennai. The research will not only provide novel data on pain levels in the developing world, but also quantify the causal impact of pain on previously unstudied outcomes and provide data to apply for funding for a larger and longer-duration study on the impact of pain reduction on productivity in the labor market (as measured by daily earnings), broader cognitive and health outcomes, as well as decision-making.
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Award Dates: 
July 1, 2017 - March 30, 2018