Pain care deserts: the U.S. counties with no pain management clinic
Original research by Rich Shea, PainBeacon founder · Updated 2026-09-11 · Based on 12,487 clinic locations in the federal NPI registry
1,906 of the 3,144 counties in the United States — 61% — have no pain management clinic. About 38 million Americans (11.3% of the population) live in these pain care deserts, where seeing a pain specialist means traveling to another county.
- No pain clinic
- 1
- 2–4
- 5–9
- 10 or more
Key findings
- 61% of U.S. counties have no pain management clinic. 1,906 of 3,144 counties across the 50 states and Washington, D.C. have zero practices registered under a pain medicine specialty.
- 38 million Americans live in a pain care desert. That is 11.3% of the U.S. population without a pain management practice in their home county.
- Another 366 counties are one closure away. 18 million people live in a county served by exactly one pain management clinic.
- Access varies sharply by state. In North Dakota, 96% of counties have no pain clinic, while in Washington, D.C. nearly every county has at least one.
The largest pain care deserts
These are the most populous U.S. counties with no pain management clinic — places where tens or hundreds of thousands of residents have no in-county option.
| # | County | State | Population |
|---|---|---|---|
| 1 | Linn County | IA | 231,762 |
| 2 | Minnehaha County | SD | 208,639 |
| 3 | Licking County | OH | 184,898 |
| 4 | Muskegon County | MI | 177,428 |
| 5 | Hampshire County | MA | 165,399 |
| 6 | Schenectady County | NY | 162,261 |
| 7 | Rensselaer County | NY | 160,749 |
| 8 | Scott County | MN | 157,206 |
| 9 | Marathon County | WI | 139,091 |
| 10 | Ascension Parish | LA | 133,534 |
| 11 | La Crosse County | WI | 121,060 |
| 12 | Liberty County | TX | 115,042 |
| 13 | Cass County | MO | 113,873 |
| 14 | Carver County | MN | 112,628 |
| 15 | Adams County | PA | 107,914 |
| 16 | Woodbury County | IA | 107,257 |
| 17 | Grant County | WA | 104,717 |
| 18 | Fond du Lac County | WI | 104,269 |
| 19 | Burleigh County | ND | 103,107 |
| 20 | Suffolk city | VA | 103,105 |
| 21 | Sherburne County | MN | 103,059 |
| 22 | Rogers County | OK | 101,371 |
| 23 | Frederick County | VA | 98,109 |
| 24 | St. Croix County | WI | 97,954 |
| 25 | Lenawee County | MI | 97,746 |
Pain clinic access by state
Sorted by the share of counties with no pain management clinic. "Clinics per 100k" is the number of registered pain management practice locations per 100,000 residents.
| State | Clinics | Per 100k | Counties | Deserts | % deserts | People in deserts |
|---|---|---|---|---|---|---|
| North Dakota | 6 | 0.75 | 53 | 51 | 96% | 527,196 |
| South Dakota | 9 | 0.97 | 66 | 60 | 91% | 681,099 |
| Nebraska | 53 | 2.64 | 93 | 83 | 89% | 593,284 |
| Minnesota | 49 | 0.85 | 87 | 76 | 87% | 2,079,000 |
| Montana | 18 | 1.58 | 56 | 48 | 86% | 357,620 |
| Iowa | 44 | 1.36 | 99 | 83 | 84% | 1,573,495 |
| Kansas | 78 | 2.63 | 105 | 88 | 84% | 870,422 |
| Alaska | 32 | 4.32 | 30 | 23 | 77% | 121,802 |
| West Virginia | 42 | 2.37 | 55 | 41 | 75% | 788,766 |
| Arkansas | 82 | 2.66 | 75 | 53 | 71% | 1,016,299 |
| Missouri | 151 | 2.42 | 115 | 81 | 70% | 1,422,195 |
| Wyoming | 21 | 3.57 | 23 | 16 | 70% | 220,668 |
| Idaho | 49 | 2.45 | 44 | 30 | 68% | 412,711 |
| Kentucky | 194 | 4.23 | 120 | 82 | 68% | 1,407,368 |
| Mississippi | 75 | 2.55 | 82 | 56 | 68% | 1,009,949 |
| Texas | 1,410 | 4.51 | 254 | 170 | 67% | 2,758,942 |
| Utah | 94 | 2.68 | 29 | 19 | 66% | 371,697 |
| Illinois | 449 | 3.53 | 102 | 65 | 64% | 1,233,135 |
| Oregon | 91 | 2.13 | 36 | 23 | 64% | 728,612 |
| Virginia | 224 | 2.54 | 133 | 85 | 64% | 1,955,809 |
| Wisconsin | 96 | 1.61 | 72 | 46 | 64% | 1,730,970 |
| Oklahoma | 179 | 4.37 | 77 | 48 | 62% | 938,862 |
| Colorado | 230 | 3.86 | 64 | 39 | 61% | 365,372 |
| Louisiana | 137 | 2.98 | 64 | 39 | 61% | 976,003 |
| New Mexico | 48 | 2.25 | 33 | 20 | 61% | 430,455 |
| Tennessee | 211 | 2.92 | 95 | 57 | 60% | 1,496,011 |
| Nevada | 170 | 5.2 | 17 | 10 | 59% | 139,139 |
| Georgia | 494 | 4.42 | 159 | 88 | 55% | 1,576,880 |
| Michigan | 325 | 3.2 | 83 | 45 | 54% | 1,401,452 |
| Washington | 155 | 1.95 | 39 | 21 | 54% | 910,957 |
| Alabama | 144 | 2.79 | 67 | 35 | 52% | 808,520 |
| Maine | 21 | 1.49 | 16 | 8 | 50% | 345,667 |
| Vermont | 12 | 1.85 | 14 | 7 | 50% | 239,819 |
| Indiana | 238 | 3.44 | 92 | 45 | 49% | 1,190,107 |
| South Carolina | 216 | 3.94 | 46 | 17 | 37% | 423,540 |
| Ohio | 316 | 2.66 | 88 | 32 | 36% | 1,228,969 |
| New York | 830 | 4.18 | 62 | 22 | 35% | 1,304,855 |
| North Carolina | 283 | 2.56 | 100 | 33 | 33% | 827,032 |
| Florida | 1,351 | 5.78 | 67 | 21 | 31% | 484,859 |
| Massachusetts | 120 | 1.68 | 14 | 4 | 29% | 272,001 |
| California | 1,210 | 3.07 | 58 | 15 | 26% | 415,344 |
| Arizona | 514 | 6.78 | 15 | 3 | 20% | 76,910 |
| Hawaii | 29 | 2.01 | 5 | 1 | 20% | 81 |
| Rhode Island | 26 | 2.34 | 5 | 1 | 20% | 50,145 |
| Pennsylvania | 439 | 3.36 | 67 | 13 | 19% | 447,320 |
| Connecticut | 99 | 2.69 | 9 | 1 | 11% | 97,701 |
| New Hampshire | 43 | 3.05 | 10 | 1 | 10% | 52,580 |
| Maryland | 530 | 8.46 | 24 | 1 | 4% | 25,241 |
| Delaware | 66 | 6.27 | 3 | 0 | 0% | 0 |
| New Jersey | 689 | 7.25 | 21 | 0 | 0% | 0 |
| Washington, D.C. | 13 | 1.85 | 1 | 0 | 0% | 0 |
Download the data
The full county-level table (3,144 rows: county, state, population, clinic count, desert flag) is free to download and reuse with attribution: pain-care-deserts.csv.
How to cite this study
Shea, R. (2026). Pain Care Deserts: U.S. Counties With No Pain Management Clinic. PainBeacon. https://painbeacon.com/research/pain-care-deserts/ — based on federal NPI registry data and U.S. Census Bureau vintage-2024 population estimates.
Methodology
Clinic locations. We start from the federal National Provider Identifier (NPI) registry (NPPES), the U.S. government's master file of healthcare providers, filtered to practices registered under pain medicine taxonomies (interventional pain medicine, pain medicine, and related specialties). Records are de-duplicated to one entry per practice location (12,487 locations at the time of this analysis), the same dataset that powers the PainBeacon directory.
County assignment. Each clinic is assigned to a county via the Census Bureau's 2020 ZCTA-to-county relationship file, using the county containing the largest share of the ZIP code's land area. 12,405 of 12,487 locations mapped to a county in the 50 states or D.C.; the remainder (territories and non-geographic ZIPs) are excluded.
Population. County population figures are U.S. Census Bureau vintage-2024 estimates. The analysis covers the 3,144 counties and county-equivalents of the 50 states plus Washington, D.C.
Limitations. NPI registration reflects where practices are registered, which can lag openings, closures, and relocations. A county with no registered pain management practice may still have primary-care physicians who manage pain, and residents near county lines may have access across the border. County-level analysis measures local availability, not drive time. The land-area assignment rule also works against small county-equivalents: where a ZIP code spans an independent city and the larger county around it, the clinics in that ZIP are credited to the county, so a handful of Virginia's independent cities are counted as deserts even where a practice operates inside the city limits.
Frequently asked questions
What is a pain care desert?
A pain care desert is a U.S. county with no pain management clinic. In this analysis, 1,906 of the nation's 3,144 counties (61%) had no practice registered in the federal NPI registry under a pain medicine specialty, leaving about 38 million residents without a local pain management option.
How many Americans live in a county with no pain clinic?
Approximately 38 million people — 11.3% of the U.S. population — live in one of the 1,906 counties with no pain management clinic. A further 18 million live in a county served by exactly one clinic.
Which data does this analysis use?
Clinic locations come from the U.S. federal NPI registry (NPPES), filtered to practices with pain medicine taxonomies and de-duplicated to one record per practice location. County assignment uses the Census Bureau's 2020 ZCTA-to-county crosswalk, and population figures are Census Bureau vintage-2024 county estimates. The full county-level table is available as a free CSV download.
Can I cite or republish these figures?
Yes — these statistics are free to cite with attribution and a link to PainBeacon (https://painbeacon.com/research/pain-care-deserts/). Journalists can download the full county-level dataset below; for questions or custom cuts of the data, use the contact options in the site footer.