Health inequalities in chronic pain

Chronic pain occurs more often among socially, economically and historically marginalised groups ^12,13. Chronic pain prevalence in adults ranges from 50% in the most deprived Scottish Index of Multiple Deprivation (SIMD) areas to 29% in the least deprived areas¹⁴. Prescribing data for medications commonly used for pain shows higher levels in areas of deprivation, as demonstrated in the chart below.

Proportion of adults in Scotland receiving a prescription by class of medicine and deprivation

Click on the image to view a larger version

While the main drivers of health inequalities lie outwith healthcare, our services and the way they are delivered play important roles. In this small section we raise awareness of health and healthcare inequalities and connect to emerging evidence on effective ways of mitigating inequalities in healthcare. This section is supported by the supplementary information section below where fuller explanations and literature citations are given, including the intersectional nature of health inequalities i.e. that health inequalities can be more fully understood by exploring factors beyond only socioeconomic deprivation.

Scotland has high levels of health inequalities¹⁵,  with poorer areas experiencing worsening health​​. Health inequalities are ‘unjust and avoidable differences in people’s health across the population and between specific population groups’¹⁶.  There are many possible reasons why chronic pain is experienced inequitably including: 

• the complex nature of chronic pain  
• the understanding of chronic pain as a defined diagnosis 
• the subjective and invisible nature of pain 
• the relationship that pain has with distress, trauma and mental health conditions

In the context of undertaking medication reviews, approaches to care can be adopted to account for some of the factors that maintain inequalities. If any service improvement approaches are being undertaken, accounting for equitable care should be considered, and the supplementary information section below contains further details of supporting literature and resources to help. 

Approaches to consider in delivering care include:

• Raising healthcare professional (HCP) education and awareness of health inequalities, driving factors, impacts on individuals and the limitations of tackling inequalities solely through healthcare
• Consideration of additional support that might be needed to reduce barriers at service interfaces e.g. support mechanisms to help attendance at specialist appointments or care coordinators
• Continuity, building relationships and trust in delivery of care is helpful in particular for marginalised groups. Service design aspects to consider: continuity in timetabling, personal lists and longer consultations
• Improving healthcare professionals’ understanding of power imbalance – understanding that different groups may hold different levels of power that influences consultations, and can inhibit people asking questions that matter, leading to over-medicalisation  
• Health literacy involves a functional understanding of any health condition. It supports the ability and opportunity to implement management and to navigate health systems. To promote health literacy within healthcare, use verbal communication strategies, accessible information, easy-to-navigate services and flexible care  
• Trauma-informed approaches to health service provision are typically service-wide with connections to trauma treatment options. In consultations it is important to give space to develop trust and for people to tell their stories; fostering individual choice and control, and being sensitive and aware of cultural, historical and gender-related issues
• Welfare and financial inclusion – HCPs can routinely enquire about money worries and signpost patients to welfare resources g. Citizen’s Advice Bureau.

Health inequalities in chronic pain