The cost of chronic pain

Background: Chronic pain conditions are amongst the costliest illnesses globally. In the UK, between one-third to one-half of the adult population presents to the National Health Service (NHS) with a chronic pain condition—with back pain alone costing over one-fifth of NHS expenditure. Despite the plethora of research on chronic pain, how the "costs" of chronic pain are defined, and the evidence for, and provision of, effective interventions that mitigate these costs, remains inconsistent. Aims and Methods: This thesis first aimed to examine how the academic literature of the last decade conceptualised the costs of chronic pain through a systematic scoping review (Study 1). Next, this thesis examined the costs of chronic pain on the quality of life factors named by sufferers by conducting binomial logistic regressions on the Health Survey for England, 2017 dataset (Study 2). Finally, this thesis explored the impact of surgery on knee-related quality of life by conducting ANCOVAs on a clinical dataset (Study 3). Results and Conclusions: Findings indicate that academia and patients agree that the subdomains of the construct of quality of life (i.e. mobility, activities of daily living, working capacity, and social and psychological functioning) are the main costs of chronic pain—with patients additionally naming a subdomain of financial security as a cost. Study 2 demonstrated that those with chronic pain are significantly worse off compared to their non-clinical counterparts on each subdomain of quality of life. Finally, Study 3 demonstrated that despite significant improvements in knee-related quality of life postsurgery—these improvements could not be statistically attributed to the surgery itself. Taken together, these studies suggest that chronic pain interventions must holistically address all subdomains of quality of life—as well as financial security—if they are to truly ameliorate the costs of chronic pain on an individual and national level.