Mortality of adults with chronic noncancer pain: a systematic review and meta-analysis

It is recognised that chronic pain is one of the leading causes of disabilities worldwide. However, statistics on mortality and causes of death in people with chronic noncancer pain (CNCP) have been difficult to determine. This systematic review aimed to determine the mortality rate in people with all types of CNCP and the associated causes and risk factors of death. MEDLINE (Ovid) and EMBASE (Ovid) were searched on 23 March 2023 to identify epidemiological studies reporting mortality in people with CNCP. Nineteen observational studies were included. There were 28,740 deaths (7%) reported in a population of 438,593 people with CNCP (n=16 studies), giving a mortality rate of 6,553 deaths per 100,000 people. An exploratory meta-analysis found that the relationship between mortality and CNCP was statistically significant (mortality risk ratio: 1.47; 95% CI: 1.22-1.77; n=11 studies) when comparing people with CNCP to those without pain. People with CNCP were more likely to die from cardiovascular disease whereas those without pain were more likely to die from malignancy, respiratory and gastrointestinal diseases. Smoking, lower physical activity levels, and opioid use were risk factors for death in people with CNCP. This systematic review found that people with CNCP have a higher risk of mortality than people without chronic pain. To reduce mortality rates in people with CNCP, cardiovascular diseases and risk factors for death should be considered when managing people with CNCP.