People with a lower socioeconomic background were twice as likely to develop chronic pain following injury, a new study has found.
In a systematic review of evidence, researchers from the University of Birmingham found that chronic pain was strongly associated with socioeconomic background. Other factors, such as a fear of movement, smoking and poorer support networks, also played a part in the development of chronic pain.
People who experienced a combination of these environmental factors were found to be up to seven times more likely to develop chronic pain after injury.
The findings, published in the journal PLOS One, highlight an association between a patient’s circumstances and the likelihood of developing chronic pain.
The scientists say there is a need to treat chronic pain differently, moving away from treating the injury site and taking a more ‘person-centred’ approach focusing on each patient’s ‘broader biological, psychosocial and social well-being’.
Chronic pain is pain that is still present three months after the initial injury. Since the body’s healing processes typically occur in under three months, the reasons behind continued pain are thought to be complex. Within the UK, 43 per cent of people suffer from chronic musculoskeletal pain, which often persists indefinitely, leading to a poorer quality of life. People with chronic pain are also more likely to develop diseases such as cancer and diabetes, as well as poor cardiovascular health.
The study was an umbrella review which involved searching ten databases, including the Cochrane Database of Systematic Reviews and Ovid Medline, as well as Google Scholar and grey literature such as Government reviews, from database inception to April 2023 to establish which biological, psychological, and social factors are associated with the development of chronic musculoskeletal pain. After reviewing the sources, 13 systematic reviews were included in the review, comprising of 185 original research studies involving 489,644 participants.
The researchers found that 34 biopsychosocial factors are associated with the development of chronic musculoskeletal pain. Factors such as smoking, fear avoidance, poorer support networks, lower socioeconomic status and high levels of pain are most strongly associated with the development of chronic musculoskeletal pain.
Lead author Michael Dunn of the University of Birmingham and St George’s University Hospitals NHS Foundation Trust said: ‘Put simply, current healthcare approaches do not address all the reasons people do not get better.’
‘The purpose of acute pain is to alter behaviour to protect the body from harm, but chronic pain persists because of a sensitised nervous system that continues our experience of pain, even after the healing process has completed.’
The researchers also identified other factors related to developing chronic pain, such as lower job satisfaction, stress and depression. These characteristics were supported by lower-quality evidence but are also linked to lower socioeconomic backgrounds.
Mr Dunn continued: ‘People from lower socioeconomic backgrounds are twice as likely to develop chronic pain after injury. This indicates that not only are current healthcare approaches inadequate, they may also be discriminatory, with current healthcare approaches that are orientated around the injured body part being geared towards those from higher socioeconomic backgrounds who are less likely to experience these psychological or social factors.’
