Inequalities and inequities in the types of chronic pain services available in areas of differing deprivation across England

Objectives: In England, the prevalence of chronic pain is higher in more deprived compared to less deprived areas. Patients in such areas also experience more severe and disabling pain than those in less deprived areas. However, little is known about whether the distribution of services for chronic pain reflect these ranging levels of need. This study examines how the types of services available for chronic pain patients vary between healthcare providers in England, serving areas of differing deprivation. Methods: National guidelines regarding primary as well the 8 commonest causes of secondary chronic pain (in the United Kingdom) were used to compile a list of services that have been recommended for supporting chronic pain patients. After searching the websites of 63 randomly selected National Health Service (NHS) Trusts and contacting their pain receptionists and/or secretaries, it was recorded whether the Trusts were providing each of these recommended chronic pain services. Mean Index of Multiple Deprivation 2019 scores were used to compare deprivation levels of areas covered by each NHS Trust. Results: There was no significant difference in the overall number of types of chronic pain services provided by NHS Trusts serving areas of differing deprivation, but deprived areas were being disadvantaged with regards to specific services. These areas were significantly (p<0.05) less likely to have occupational therapy, return-to-work programmes, and hand therapy services. Areas with fewer types of professionals (<= 3) in their pain multidisciplinary team were also significantly (p<0.05) more deprived than those with more types (>3). Conclusion: There are significant differences in the provision of certain types of chronic pain services between areas of differing deprivation. Similar research across Europe is recommended to inform policy to combat the widespread chronic pain related health inequalities.