References

Chronic pain: Quality prescribing - A guide for improvement 2026-2029
Scottish Government Effective Prescribing & Therapeutics Division
  1. International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization (WHO) 2019/2021
    Definitions of Chronic Pain Syndromes - International Association for the Study of Pain (IASP)
  2. Scottish Government Polypharmacy Model of Care Group. Polypharmacy guidance, realistic prescribing. 3rd ed. Scottish Government; 2018.
  3. Royal Pharmaceutical Society, Pharmacy’s Role in Climate Action and Sustainable Healthcare
  4. Department of Health and Social Care, Good for you, good for us, good for everybody A plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions, 2021.
  5. Tennison I., Roschnik S., Ashby B., et al. Health care's response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health. 2021;5(2):e84-e92. doi:10.1016/S2542-5196(20)30271-
  6. Bussières A., Hancock M.J., Elklit A., et al. Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a systematic review and meta-analysis. Eur J Psychotraumatol. 2023;14(2):2284025. doi:10.1080/20008066.2023.2284025
  7. IASP Terminology. 2023.Terminology | International Association for the Study of Pain
  8. El-Boghdadly K., Levy N.A., Fawcett W.J., et al. Peri-operative pain management in adults: a multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society. Anaesthesia. 2024;79(11):1220-1236. doi:10.1111/anae.16391
  9. van Rysewyk S., Blomkvist R., Chuter A., et al. Understanding the lived experience of chronic pain: A systematic review and synthesis of qualitative evidence syntheses. Br J Pain. 2023;17(6):592-605. doi:10.1177/20494637231196426
  10. Torrance N., Veluchamy A., Zhou Y., et al. Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland. Br J Anaesth. 2020;125(2):159-167. doi:10.1016/j.bja.2020.05.017
  11. Muller S, Bailey J, Bajpai R, et al. Risk of adverse outcomes during gabapentinoid therapy and factors associated with increased risk in UK primary care using the clinical practice research datalink: a cohort study. Pain. 2024;165(10):2282-2290. doi:10.1097/j.pain.0000000000003239
  12. Craig, K. D., Holmes, C., Hudspith, M., et al. (2019). Pain in persons who are marginalized by social conditions. Pain, 161(2)10.1097/j.pain.0000000000001719
  13. Macgregor, C., Walumbe, J., Tulle, E., et al. (2023). Intersectionality as a theoretical framework for researching health inequities in chronic pain. British Journal of Pain, 17(5)10.1177/20494637231188583
  14. Scottish Government. (2023). Scottish Health Survey 2022 main report – volume 1. 
  15. Miall, N., Fergie, G., & Pearce, A., Health Inequalities in Scotland: trends in deaths, health and wellbeing, health behaviours, and health services since 2000. University of Glasgow, 2022. 10.36399/gla.pubs.282637
  16. McCartney, G., Popham, F., McMaster, R., et al., Defining health and health inequalities. Public Health, 2019; 172, 22–30. 10.1016/j.puhe.2019.03.023
  17. Scottish Intercollegiate Guidelines Network (SIGN), Management of Chronic Pain SIGN 136, 2019.
  18. National Institute for Health and Clinical Excellence NG193, Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain 2021
  19. National Institute of Health and Care Excellence (NICE), Clinical Knowledge Summaries, Chronic pain, January 2025
  20. Faculty of Pain Medicine of the Royal College of Anaesthetists, Core standards for pain management services in the UK, 2021
  21. National Institute of Health and Care Excellence (NICE), Clinical Knowledge Summaries, Red flag signs and symptoms, January 2025
  22. Bennett M.I., Smith B.H., Torrance N., Potter J., The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain. 2005;6(3):149-158. doi:10.1016/j.jpain.2004.11.007
  23. Cartagena Farias J., Porter L., McManus S. et al. (2017) Prescribing patterns in dependence forming medicines. London: NatCen.
  24. Drug-related deaths in Scotland in 2023 - National Records of Scotland (NRS)
  25. James J. Dealing with drug-seeking behaviour. Aust Prescr. 2016;39(3):96-100. doi:10.18773/austprescr.2016.022
  26. National Institute for Health and Clinical Excellence NG64 Drug misuse prevention: targeted interventions. 2017
  27. McCracken L.M., Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain. 1998;74(1):21-27. doi:10.1016/S0304-3959(97)00146-2
  28. Chen Y., Sun J., Li Y., et al. Pain Acceptance: A Concept Analysis. Pain Manag Nurs. Published online March 8, 2025. doi:10.1016/j.pmn.2025.02.009
  29. Williams A.C., Eccleston C., Morley S., Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012;11(11):CD007407. Published 2012 Nov 14. doi:10.1002/14651858.CD007407.pub3
  30. Rosser B.A., Fisher E., Janjua S., et al. Psychological therapies delivered remotely for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2023;8(8):CD013863. Published 2023 Aug 29. doi:10.1002/14651858.CD013863.pub2
  31. Hilton L., Hempel S., Ewing B.A., et al. Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Ann Behav Med. 2017 Apr;51(2):199-213. doi: 10.1007/s12160-016-9844-2. PMID: 27658913; PMCID: PMC5368208.
  32. Skelly A.C., Chou R., Dettori J.R., et al. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Rockville (MD): Agency for Healthcare Research and Quality (US); April 2020.
  33. Franqueiro A.R., Yoon J., Crago M.A., et al., The Interconnection Between Social Support and Emotional Distress Among Individuals with Chronic Pain: A Narrative Review. Psychol Res Behav Manag. 2023 Oct 27;16:4389-4399.
  34. Whibley D., AlKandari N., Kristensen K., et al. Sleep and Pain: A Systematic Review of Studies of Mediation. Clin J Pain. 2019;35(6):544-558. doi:10.1097/AJP.0000000000000697
  35. Mork P.J., Nilsen T.I., Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis Rheum. 2012;64(1):281-284. doi:10.1002/art.33346
  36. Whale K., Dennis J., Wylde V., et al. The effectiveness of non-pharmacological sleep interventions for people with chronic pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2022;23(1):440. Published 2022 May 11. doi:10.1186/s12891-022-05318-5
  37. Scottish Intercollegiate Guidelines Network (SIGN), SIGN 173 Management of chronic pain (part 1), 2025. (last accessed 10 February 2026)
  38. de Zoete R.M., Armfield N.R., McAuley J.H., et al. Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials. Br J Sports Med. Published online November 2, 2020. doi:10.1136/bjsports-2020-102664
  39. Brain K., Burrows T.L., Rollo M.E., et al. A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain. J Hum Nutr Diet. 2019;32(2):198-225. doi:10.1111/jhn.12601
  40. Gregori D., Giacovelli G., Minto C., et al. Association of pharmacological treatments with long-term pain control in patients with knee osteoarthritis: a systematic review and meta-analysis. Jama. 2018;320(24):2564-79. 
  41. Wilson M.V., Braithwaite F.A., Arnold J.B., et al. The effectiveness of peer support interventions for community-dwelling adults with chronic musculoskeletal pain: a systematic review and meta-analysis of randomised trials. Pain. 2024;165(12):2698-2720. doi:10.1097/j.pain.0000000000003293
  42. UK Government, Medicines and Healthcare Products Regulatory Agency, Drug Safety Update, 2020 Opioids: risk of dependence and addiction
  43. Public Health England, 2019. Dependence and withdrawal associated with some prescribed medicines. London [online]
  44. Derry, S., Bell, R.F., Straube, S., et al. Pregabalin for neuropathic pain in adults. 2019, Cochrane Database of Systematic Reviews, (1).
  45. National Institute for Health and Care Excellence (NICE) Low back pain and sciatica in over 16s: assessment and management [NG59] 2020
  46. McDonagh M.S., Selph S.S., Buckley D.I., et al. Nonopioid pharmacologic treatments for chronic pain.  Rockville (MD): Agency for Healthcare Research and Quality (US); April 2020.
  47. National Institute for Health and Care Excellence (NICE) Osteoarthritis in over 16s: diagnosis and management October 2022
  48. Roberts E., Delgado Nunes V., Buckner S., et al. Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Ann Rheum Dis. 2016;75(3):552-559. doi:10.1136/annrheumdis-2014-206914
  49. British National Formulary 2025
  50. British National Formulary Treatment Summary: Non-steroidal anti-inflammatory drugs
  51. Richards, D. The Oxford Pain Group League table of analgesic efficacy. Evid Based Dent 5, 22–23 (2004). https://doi.org/10.1038/sj.ebd.6400237
  52. Derry, S., Wiffen, P.J., Häuser, W., et al. Oral nonsteroidal anti‐inflammatory drugs for fibromyalgia in adults. 2017. Cochrane Database of Systematic Reviews, (3).
  53. Korownyk, C.S., Montgomery, L., Young, J., et al. PEER simplified chronic pain guideline: Management of chronic low back, osteoarthritic, and neuropathic pain in primary care. 2022. Canadian Family Physician, 68(3), pp.179-190
  54. Cashin, A.G., Wand, B.M., O'Connell, N.E., et al. Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews. 2023. Cochrane Database of Systematic Reviews, (4).
  55. Wiffen P.J., Xia J., Systematic review of topical diclofenac for the treatment of acute and chronic musculoskeletal pain. Current medical research and opinion 2020;36(4):637-50.
  56. AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023; 71(7): 2052-2081. doi:10.1111/jgs.18372
  57. Specialist Pharmacy Service Using NSAIDs in asthma July 2024
  58. Nury, E., Schmucker, C., Nagavci, B., et al. Efficacy and safety of strong opioids for chronic noncancer pain and chronic low back pain: a systematic review and meta-analyses. Pain, 2022;163(4), pp.610-636.
  59. Petzke, F., Klose, P., Welsch, P., et al. Opioids for chronic low back pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks of double‐blind duration. European Journal of Pain, 2020; 24(3), pp.497-517.
  60. Chou R., Hartung D., Turner J., et al. Opioid Treatments for Chronic Pain. Agency for Healthcare Research and Quality 2020:04
  61. Noori A., Sadeghirad B., Wang L. et al. Comparative benefits and harms of individual opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised trials. British Journal of Anaesthesia 2022;129:394-406.
  62. Chou R., Selph S., Wagner J. et al. Systematic Review on Opioid Treatments for Chronic Pain: Surveillance Report 1. Rockville, MD: Agency for Healthcare Research and Quality; 2022.
  63. Chou R., Selph S., Wagner J. et al, Systematic Review on Opioid Treatments for Chronic Pain: Surveillance Report 2. Rockville, MD: Agency for Healthcare Research and Quality; 2022.
  64. Chou R., Selph S., Wagner J. et al. Systematic Review on Opioid Treatments for Chronic Pain: Surveillance Report 3. Rockville, MD: Agency for Healthcare Research and Quality; 2022.
  65. Dowell D., Ragan K.R., Jones C.M., et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep 2022;71(3):1-95
  66. Faculty of Pain Medicine, Opioids Aware
  67. Jani M., Girard N., Bates D.W., et al. Comparative risk of mortality in new users of prescription opioids for noncancer pain: results from the International Pharmacosurveillance Study. Pain 2024.
  68. Bedson J., Chen Y., Ashworth J., et al. Risk of adverse events in patients prescribed long-term opioids: A cohort study in the UK Clinical Practice Research Datalink. Eur J Pain 2019;23(5):908-22.
  69. NHS Inform, Chronic Pain
  70. Mattia C., Luongo L., Innamorato M., et al. An Italian expert consensus on the use of opioids for the management of chronic non-oncological pain in clinical practice: focus on buprenorphine. Journal of Pain Research. 2021;14(3193-3206.
  71. Elmoheen, A., Nazal, A.F., Zubaidi, O., et al. Expert review and recommendations for the management of acute, chronic, and neuropathic pain in Qatar. Qatar Medical Journal, 2021(2), p.19.
  72. Nagar V.R., Birthi P., Salles S., Sloan P.A., Opioid Use in Chronic Pain Patients with Chronic Kidney Disease: A Systematic Review. Pain medicine (Malden, Mass) 2017;18:1416–49
  73. Chou, R., Turner, J.A., Devine, E.B., et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. 2015. Annals of internal medicine, 162(4), pp.276-286.
  74. Colvin, L.A. and Fallon, M.T., 2010. Opioid-induced hyperalgesia: a clinical challenge. British journal of anaesthesia, 104(2), pp.125-127.
  75. Daniell, H.W., 2002. Hypogonadism in men consuming sustained-action oral opioids. The Journal of Pain, 3(5), pp.377-384.
  76. Daniell, H.W., 2008. Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain. The Journal of Pain, 9(1), pp.28-36.
  77. Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression - GOV.UK
  78. UK Government, Medicines and Healthcare Products Regulatory Agency, Drug Safety Update 2017. Gabapentin (Neurontin): risk of severe respiratory depression.
  79. UK Government, Medicines and Healthcare Products Regulatory Agency, Drug Safety Update, 2021. Pregabalin (Lyrica)): reports of severe respiratory depression.
  80. US Food and Drug Administration, Drug safety communication: FDA recommends health care professionals discuss naloxone with all patients when prescribing opioid pain relievers or medicines to treat opioid use disorder, 2020
  81. Birkinshaw H., Friedrich C.M., Cole P., et al. Antidepressants for pain management in adults with chronic pain: a network meta-analysis. Cochrane Database of Systematic Reviews 2023;5:CD014682.
  82. Welsch P., Üçeyler N., Klose P., et al. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database of Systematic Reviews 2018(2).
  83. Fenske, J.N., Berland, D.W., Chandran, S., et al. Ambulatory Pain Management Guideline 2021, University of Michigan
  84. Mair A., Fernandez-Limos F., Alonso A., et al. Polypharmacy Management by 2030: a patient safety challenge, 2nd Edition. Coimbra: SIMPATHY Consortium, 2017.
  85. Migliorini F., Maffulli N., Eschweiler J., et al. The pharmacological management of chronic lower back pain. Expert opinion on pharmacotherapy. 2021;22(1):109-119.
  86. Scottish Government Quality prescribing for antidepressants: guide for improvement 2024 to 2027 - gov.scot
  87. Taylor, D.M., Barnes, T.R. and Young, A.H., 2021. The Maudsley prescribing guidelines in psychiatry. John Wiley & Sons.
  88. Enke, O., New, H.A., New, C.H., et al. Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis. 2018. Cmaj, 190(26), pp.E786-E793.
  89. Centre for Clinical Practice at NICE (UK, 2013. Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings [Internet].  Updated 2020
  90. Moore, R.A., Wiffen, P.J., Derry, S. and Rice, A.S., 2014. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane database of systematic reviews, (4).
  91. Wiffen P.J., Derry S., Moore R.A. and Kalso E.A., Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD005451. DOI: 10.1002/14651858.CD005451.pub3. Accessed 21 May 2025.
  92. UK Government, Medicines and Healthcare Products Regulatory Agency, Drug Safety Update, 2021. Pregabalin (Lyrica): findings of safety study on risks during pregnancy.
  93. Falk, J., Thomas, B., Kirkwood, J., et al. 2021. PEER systematic review of randomized controlled trials: Management of chronic neuropathic pain in primary care. Canadian Family Physician, 67(5), pp.e130-e140. available at: PEER systematic review of randomized controlled trials | The College of Family Physicians of Canada
  94. Derry S., Rice A.S., Cole P., et al. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;1(1):CD007393. Published 2017 Jan 13. doi:10.1002/14651858.CD007393.pub4
  95. Specialist Pharmacy Service: Use of nefopam for chronic pain, January 2024
  96. Richards B.L., Whittle S.L., Buchbinder R.. Neuromodulators for pain management in rheumatoid arthritis. Cochrane Database Syst Rev. 2012;1(1):CD008921. Published 2012 Jan 18. doi:10.1002/14651858.CD008921.pub2
  97. Stockings E., Campbell G., Hall W.D., et al. Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain. 2018 Oct;159(10):1932-1954. DOI: 10.1097/j.pain.0000000000001293. PM
  98. Dykukha I., Malessa R., Essner U. and Überall M.A., Nabiximols in chronic neuropathic pain: a meta-analysis of randomized placebo-controlled trials. Pain Medicine. 2021;22(4):861-74.
  99. Johal H., Devji T., Chang Y., et al., Cannabinoids in chronic non-cancer pain: a systematic review and meta-analysis. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2020;13:1179544120906461.
  100. McDonagh M.S., Morasco B.J., Wagner J., et al., Cannabis-based products for chronic pain: a systematic review. Annals of internal medicine. 2022;175(8):1143-53.
  101. McParland A.L., Bhatia A., Matelski J., et al., Evaluating the impact of cannabinoids on sleep health and pain in patients with chronic neuropathic pain: a systematic review and meta-analysis of randomized controlled trials. Regional Anesthesia & Pain Medicine. 2023;48(4):180-90.
  102. Mücke M., Phillips T., Radbruch L., et al., Cannabis‐based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2018(3).
  103. Wang L., Hong P.J., May C., et al,. Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials. BMJ. 2021;374.
  104. IASP Presidential Task Force on Cannabis and Cannabinoid Analgesia. International Association for the Study of Pain Presidential Task Force on Cannabis and Cannabinoid Analgesia position statement. PAIN 162():p S1-S2, July 2021.
  105. British Pain Society Position statement on the medicinal use of cannabinoids in pain management October 2018
  106. Wong S.S.C., Chan W.S., Cheung C.W., Analgesic effects of cannabinoids for chronic non-cancer pain: a systematic review and meta-analysis with meta-regression. Journal of Neuroimmune Pharmacology. 2020;15:801-29.
  107. Chou, R., Ahmed, A.Y., Dana, T., et al. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: 2024 Update
  108. National Records of Scotland 2025. Drug-related deaths in Scotland in 2024. (last accessed 6 January 2026)
  109. Lu, C.B., Liu, P.F., Zhou, Y.S., et al., Musculoskeletal pain during the menopausal transition: A systematic review and meta‐analysis. 2020, Neural plasticity, 2020(1), p.8842110.
  110. Oxford University Hospitals Pain Management Centre, Guidance for opioid reduction in primary care, October 2023
  111. Audi S., Burrage D.R., Lonsdale D.O., et al. The 'top 100' drugs and classes in England: an updated 'starter formulary' for trainee prescribers. Br J Clin Pharmacol. 2018;84(11):2562-2571. doi:10.1111/bcp.13709
  112. Levy N., Lord L.J., Lobo D.N., UK recommendations on opioid stewardship. BMJ. 2021;372:m4901. Published 2021 Jan 5. doi:10.1136/bmj.m4901
  113. Simpson A.K., Levy N., Mariano E.R., Opioid stewardship. BJA Educ. 2023;23(10):389-397. doi:10.1016/j.bjae.2023.05.007
  114. Shrestha S., Khatiwada A.P., Sapkota B., et al. What is "Opioid Stewardship"? An Overview of Current Definitions and Proposal for a Universally Acceptable Definition. J Pain Res. 2023;16:383-394. Published 2023 Feb 10. doi:10.2147/JPR.S389358
  115. Faculty of Pain Medicine: Opioids Aware – Patient assessment
  116. Right Decision Service Post surgery opioid prescribing (Guidelines)  June 2023
  117. Hyland, S.J., Brockhaus, K.K., Vincent, W.R., et al., Perioperative pain management and opioid stewardship: a practical guide, 2021. In Healthcare (Vol. 9, No. 3, p. 333). MDPI.available at: Perioperative Pain Management and Opioid Stewardship: A Practical Guide
  118. Levy N., Quinlan J., El-Boghdadly K., et al., An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients. Anaesthesia. 2021;76(4):520-536. doi:10.1111/anae.15262
  119. McAnally, H., 2017. Rationale for and approach to preoperative opioid weaning: a preoperative optimization protocol. Perioperative medicine, 6(1), p.19. available at: Rationale for and approach to preoperative opioid weaning: a preoperative optimization protocol | Perioperative Medicine
  120. Srivastava, D., Hill, S., Carty, S., et al., Surgery and opioids: evidence-based expert consensus guidelines on the perioperative use of opioids in the United Kingdom. 2021, British Journal of Anaesthesia, 126(6), pp.1208-1216.
  121. Faculty of Pain Medicine, Surgery and Opioids: Best Practice Guidelines 2021
  122. Public Health Scotland Acute hospital activity and NHS beds information (annual) September 2024
  123. OECD/European Commission, Health at a Glance: Europe 2024: State of Health in the EU Cycle, 2024. Paris: OECD Publishing. 10.1787/b3704e14-en.
  124. Raymond, A., Watt, T., Douglas, H. R., et al., Health inequalities in 2040. Current and projected patterns of illness by deprivation in England, 2024, The Health Foundation.
  125. Lucyk, K., & McLaren, L., Taking stock of the social determinants of health: a scoping review. PLoS ONE, 2017; 12(5), e0177306. 10.1371/journal.pone.0177306
  126. McCartney, G., Dickie, E., Escobar, O., and Collins, C., Health inequalities, fundamental causes and power: towards the practice of good theory. Sociology of Health and Illness, 2020; 43(1), 20–39. 10.1111/1467-9566.13181
  127. National Institute for Health and Care Excellence, NICE and Health Inequalities, 2024
  128. Krauth, S. J., Steell, L., Ahmed, S., et al., Association of latent class analysis-derived multimorbidity clusters with adverse health outcomes in patients with multiple long-term conditions: comparative results across three UK cohorts. eClinicalMedicine, 2024; 74, 10.1016/j.eclinm.2024.102703
  129. Stannard, S., Holland, E., Crozier, S. R., et al., Early-onset burdensome multimorbidity: an exploratory analysis of sentinel conditions, condition accrual sequence and duration of three long-term conditions using the 1970 British Cohort Study. BMJ. 2022; 10.1136/bmjopen-2021-059587
  130. Roberts, A., & Richards, G. C., Is England facing an opioid epidemic? British Journal of Pain, 2023; 17(3)10.1177/20494637231160684
  131. Torrance, N., Veluchamy, A., Zhou, Y., et al., Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland. British Journal of Anaesthesia, 2020; 125(2), 159. 10.1016/j.bja.2020.05.017
  132. Woodward, A., Davies, N., Walters, K., et al., Self-management of multiple long-term conditions: A systematic review of the barriers and facilitators amongst people experiencing socioeconomic deprivation. PloS One, 2023; 18(2), e0282036. 10.1371/journal.pone.0282036
  133. Craig, K. D., Holmes, C., Hudspith, M., et al., Pain in persons who are marginalized by social conditions. Pain, 2019; 161(2)10.1097/j.pain.0000000000001719
  134. Macgregor, C., Walumbe, J., Tulle, E., et al., Intersectionality as a theoretical framework for researching health inequities in chronic pain. British Journal of Pain, 2023; 17(5)10.1177/20494637231188583
  135. Scottish Government, Scottish Health Survey 2022 main report – volume 1, 2023.
  136. Public Health England, Chronic pain in adults 2017. Health survey for England, 2020.
  137. Fayaz, A., Croft, P., Langford, R. M., et al., Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open, 2016; 6(6), e010364. 10.1136/bmjopen-2015-010364
  138. Keogh, E., The gender context of pain. Health Psychology Review, 2021; 15(3), 454–481. 10.1080/17437199.2020.1813602
  139. Gatchel, R. J., Peng, Y. B., Peters, M. L., et al., The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 2007; 133(4), 581. 10.1037/0033-2909.133.4.581
  140. Pincus, T., Kim Burton, A., Vogel, S., and Field, A. P., A Systematic Review of Psychological Factors as Predictors of Chronicity/Disability in Prospective Cohorts of Low Back Pain. Spine, 2002; 27(5)10.1097/00007632-200203010-00017
  141. Hughes, K., Bellis, M. A., Hardcastle, K. A., et al., The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health, 2017; 2, e356–e366.
  142. Allen, J., Balfour, R., Bell, R., and Marmot, M., Social determinants of mental health. International Review of Psychiatry, 2014; 26(4), 392–407. 10.3109/09540261.2014.928270
  143. Doebl, S., Macfarlane, G. J., and Hollick, R. J., “No one wants to look after the fibro patient”. Understanding models, and patient perspectives, of care for fibromyalgia: reviews of current evidence. Pain, 2020; 161(8)10.1097/j.pain.0000000000001870
  144. Macgregor, C., Blane, D. N., Tulle, E., et al., An ecosystem of accepting life with chronic pain: A meta-ethnography. British Journal of Pain, 2024; 18(4)10.1177/20494637241250271
  145. Toye, F., Seers, K., Allcock, N., et al., Patients’ experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review. British Journal of General Practice, 2013; 63(617), e829. 10.3399/bjgp13x675412
  146. Cheetham, M., Moffatt, S., Addison, M., and Wiseman, A., Impact of Universal Credit in North East England: a qualitative study of claimants and support staff. BMJ. 2019; 10.1136/bmjopen-2019-029611
  147. Morgan, C. L., Conway, P., and Currie, C. J., The relationship between self‐reported severe pain and measures of socio‐economic disadvantage. European Journal of Pain, 2011; 15(10), 1107. 10.1016/j.ejpain.2011.04.010
  148. Farmer, C., Fenu, E., O’flynn, N., and Guthrie, B., Clinical assessment and management of multimorbidity: summary of NICE guidance. BMJ. 2016; 10.1136/bmj.i4843
  149. May, C. R., Eton, D. T., Boehmer, K., et al., Rethinking the patient: using burden of treatment theory to understand the changing dynamics of illness. BMC Health Services Research, 2014; 14(1), 281. 10.1186/1472-6963-14-281
  150. Smith, J. A., and Osborn, M., Pain as an assault on the self: An interpretative phenomenological analysis of the psychological impact of chronic benign low back pain. Psychology and Health, 2007; 22(5), 517. 10.1080/14768320600941756
  151. Webster, F., Connoy, L., Sud, A., et al., Chronic struggle: an institutional ethnography chronic pain and marginalization. 2023, The Journal of Pain, 24(3), 437–448. 10.1016/j.jpain.2022.10.004
  152. Blane, D., Lunan, C., Bogie, J., et al., Tackling the inverse care law in Scottish General Practice Policies, interventions and the Scottish Deep End Project. University of Glasgow, University of Edinburgh, 2024.
  153. Jain, S., Jadwani, V., Spogmy, S., and Walumbe, J. Inequalities and inequities in the types of chronic pain services available in areas of differing deprivation across England. Scandinavian Journal of Pain, 2022; 23(1), 168–174. 10.1515/sjpain-2022-0015
  154. Moore, F. R., Williams, L., and Dunbar, M., Sociodemographic predictors of attendance at a Scottish pain management programme. British Journal of Pain, 2021; 15(4), 393–400. 10.1177/2049463720970579
  155. Dixon-Woods, M., Cavers, D., Agarwal, S., et al., Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 2006; 6(1), 35. 10.1186/1471-2288-6-35
  156. Robertson, R., Blythe, N., and Jeffries, D. Tackling health inequalities on NHS waiting lists, 2023, The Kings Fund.
  157. Arthritis and Musculoskeletal Alliance. Act Now: Musculoskeletal Health Inequalities and Deprivation, 2024.
  158. Gkiouleka, A., Wong, G., Sowden, S., et al., Reducing health inequalities through general practice: a realist review and action framework. Health and Social Care Delivery Research, 2024; 12(7)10.3310/ytww7032
  159. Metzl, J. M., and Hansen, H., Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science and Medicine, 2013; 103, 126. 10.1016/j.socscimed.2013.06.032
  160. Laskawska, M. S., Hébert, H. L., Richardson, C., et al., The core minimum dataset for measuring pain outcomes in pain services across Scotland. Developing and testing a brief multi-dimensional questionnaire. British Journal of Pain, 2022; 16(5), 504–517. 10.1177/20494637221092907
  161. Lunn, A. D., Lynch, H., Bilaal, A., et al., What works: Addressing inequalities in the primary and secondary outpatient interface, Health Equity Centre, 2024.
  162. Baker, R., Freeman, G. K., Haggerty, J. L., et al., Primary medical care continuity and patient mortality: a systematic review. British Journal of General Practice, 2020; 70(698), e600. 10.3399/bjgp20x712289
  163. Palmer, W., Hemmings, N., Rosen, R., et al., Improving access and continuity in general practice Evidence review, 2018, Nuffield Trust.
  164. Dickie, E., Hearty, W., Fraser, A., et al., Power – a health and social justice issue, 2015. Edinburgh: NHS Scotland.
  165. Protheroe, J., Brooks, H., Chew-Graham, C., et al., ‘Permission to participate?’ A qualitative study of participation in patients from differing socio-economic backgrounds. Journal of Health Psychology, 2012; 18(8)10.1177/1359105312459876
  166. Brady, B., Veljanova, I., & Chipchase, L., An exploration of the experience of pain among culturally diverse migrant communities. Rheumatology Advances in Practice, 2017; 1(1), rkx002. 10.1093/rap/rkx002
  167. Brady, B., Veljanova, I., & Chipchase, L., The Intersections of Chronic Noncancer Pain: Culturally Diverse Perspectives on Disease Burden. Pain Medicine, 2019; 20(3), 434–445. 10.1093/pm/pny088s
  168. Browne, A. J., Varcoe, C., Ford-Gilboe, M., et al., Disruption as opportunity: Impacts of an organizational health equity intervention in primary care clinics. International Journal for Equity in Health, 2018; 17(1)10.1186/s12939-018-0820-2
  169. Walters, R., Leslie, S. J., Polson, R., et al., Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review. BMC Public Health, 2020; 20(1)10.1186/s12889-020-08991-0
  170. World Health Organisation, Health Literacy, 2024.
  171. Brady, B., Andary, T., Pang, S. M., et al., A Mixed-Methods Investigation into Patients’ Decisions to Attend an Emergency Department for Chronic Pain. Pain Medicine, 2021; 22(10)10.1093/pm/pnab081
  172. Lacey, R. J., Campbell, P., Lewis, M., and Protheroe, J., The Impact of Inadequate Health Literacy in a Population with Musculoskeletal Pain. HLRP: Health Literacy Research and Practice, 2018; 2(4)10.3928/24748307-20181101-01
  173. Mackey, L. M., Doody, C., Werner, E. L., and Fullen, B., Self-Management Skills in Chronic Disease Management. Medical Decision Making, 2016; 36(6)10.1177/0272989x16638330
  174. Mackey, L. M., Blake, C., Casey, M., et al., The impact of health literacy on health outcomes in individuals with chronic pain: a cross-sectional study. Physiotherapy, 2019; 105(3)10.1016/j.physio.2018.11.006
  175. NHS England, Health literacy 'how to' guide, 2020.
  176. Scottish Government, Making it Easier - a health literacy action plan, 2017.
  177. Truong, M., & Fenton, S., Understanding the Current Landscape of Health Literacy Interventions within Health Systems. Perspectives in Health Information Management, 2022; 15(19)PMID: 35692852 PMCID: PMC9123532
  178. NHS Education Scotland and Scottish Government, Scottish Psychological Trauma Training Plan, 2019.
  179. Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach, 2014, HHS Publication No. (SMA) 14-4884. RockVille, MD, USA: Substance Abuse and Mental Health Services Administration.
  180. Gopal, D. P., Hunter, M., Butler, D., et al., Trauma-informed care: what does it mean for general practice? British Journal of General Practice, 2023; 73(730), 229. 10.3399/bjgp23x732837
  181. Purkey, E., Patel, R., and Phillips, S. P., Trauma-informed care: Better care for everyone. Canadian Family Physician, 2018; 64(3), 170–172.
  182. Karran, E. L., Cashin, A. G., Barker, T., et al., The ‘what’ and ‘how’ of screening for social needs in healthcare settings: a scoping review. PeerJ, 2023; 11, e15263. 10.7717/peerj.15263
  183. Brcic, V., Eberdt, C., and Kaczorowski, J., Development of a Tool to Identify Poverty in a Family Practice Setting: A Pilot Study. International Journal of Family Medicine, 2011, 812182–7. 10.1155/2011/812182
  184. Public Health Scotland, Financial Inclusion referral Pathways, 2024.
  185. Improvement Service, Welfare Advice and Health Partnerships, 2024.
  186. Healthcare Improvement Scotland, The Quality Framework for Community Engagement and Participation, 2023. (last accessed 7 February 2025)
  187. Scottish Palliative Care Guidelines Group, Scottish Palliative Care Guidelines, 2019.
  188. World Health Organization Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. 2009.
  189. Woody, G.E., Kampman, K.K., Auriacombe, M., Disorders due to Substance Use: Opioids and Opioid Addiction, 2024. In: Tasman, A., et al. Tasman’s Psychiatry. Springer, Cham.
  190. Laupacis A., Sackett D., Roberts R., An Assessment of Clinically Useful Measures of the Consequences of Treatment. New England Journal of Medicine. 1988;318(26):1728-1733
  191. Cook R., Sackett D., The number needed to treat: a clinically useful measure of treatment effect. BMJ. 1995;310(6977):452-454
  192. McAlister, F.A., The “number needed to treat” turns 20—and continues to be used and misused. Cmaj, 2008; 179(6), pp.549-553.
  193. Guthrie B., Thompson A., Dumbreck S., et al., Better guidelines for better care: accounting for multimorbidity in clinical guidelines – structured examination of exemplar guidelines and health economic modelling. Health Serv Deliv Res 2017;5(16).