Study shows unequal access to specialized chronic pain rehabilitation

Patients with chronic pain do not have access to specialized rehabilitation on equal terms. Education, age, sex, and region of birth appear to play a role, particularly in combination, according to a Sweden-based study from the University of Gothenburg.

Chronic pain can affect work, everyday life, and quality of life. The study is based on 39,346 patients who were referred to specialized pain care in Sweden between 2009 and 2016. Nearly half of these patients (49.8 percent) were assessed as able to participate in a rehabilitation program. The study identifies several factors that appear to influence which patients gain access to specialized pain rehabilitation.

Among women, 52.1 percent were assessed as able to participate in specialized pain rehabilitation, compared with 44.1 percent of men. Among patients born in the Nordic countries, the proportion was 51.2 percent, compared with 44.7 percent among patients born outside the Nordic countries. Education also appeared to matter: 40.2 percent of patients with only compulsory education were assessed as able to participate, compared with 54.9 percent of patients with a university education.

Age also played a role. Middle-aged patients were more often assessed as able to participate than both younger and older patients. The fact that the youngest patients participated less often than middle-aged patients was unexpected, since early interventions can be important both for individuals and for society.

The study is part of Helene Svensdotter's doctoral education. She is a physiotherapist and a doctoral student at the Sahlgrenska Academy, University of Gothenburg.

"We see that the differences are not only linked to individual factors. It is the combination of factors such as educational level, age, sex, and region of birth that appears to influence the likelihood of gaining access to rehabilitation. This makes the findings important to consider when healthcare services review both assessment procedures and the types of interventions available to different patient groups."

When the researchers analyzed several factors simultaneously, the differences became more pronounced. The lowest likelihood of being offered pain rehabilitation was found among patients with a combination of primary school education and being born outside the Nordic countries, with similar patterns observed among women and men regardless of age. The highest likelihood was found among middle-aged women with a university education, regardless of whether they were born within or outside the Nordic region.

The researchers point to several possible explanations for these differences, including language-related factors, life circumstances, the ability to participate in an extensive rehabilitation program, healthcare professionals' assessments of patients' conditions and circumstances, and perceptions of who is considered suitable for rehabilitation.

The findings can be used to further develop how patients are assessed before specialized pain rehabilitation and how different types of support can be adapted. The aim is for more patients with chronic pain to receive the right intervention, regardless of their background.