Persistent Pain in Wales: Prevalence and Healthcare Utilisation from a Population-Scale Retrospective Cohort Study

Persistent pain has a significant impact on quality of life and places considerable demand on the NHS (National Health Service). In 2023, Welsh Government published their guidance Living with Persistent Pain, marking persistent pain as a national priority. The research aimed to provide evidence to help inform NHS leads in Wales around current and future services, capacity planning, and to aid in implementing health policies. We conducted a retrospective cohort study covering the period 2010-2023. Anonymised, individual- level, population-scale linked routinely-collected electronic health records and administrative data from the SAIL Databank was used. The population included people living in Wales and registered with a General Practice (GP) that provides data to SAIL. Three cohorts of people were created. These were i) people with diagnostic codes relevant to persistent pain, ii) people prescribed opioids or gabapentinoids for 3 months or more, and iii) people referred to specialist outpatient pain services. A comparator group included people who did not meet any of these criteria. We measured the proportion of the population living with persistent pain, demographic details, and health status. Healthcare use data included GP appointments and prescriptions, hospital admissions, emergency department visits, and outpatient appointments. The results showed that 15% of the population of Wales are living with persistent pain. Persistent pain was more common among older adults, women, and individuals living in more deprived areas. A higher burden of frailty and comorbid conditions was observed in the persistent pain cohort compared to the general population. People living with persistent pain had 63% more GP events than those without. Those referred to pain services had more healthcare interactions overall and were younger and less frail compared to those not referred. Trends over time showed small but statistically significant decline was observed in the prevalence of persistent pain over the study period. After adjusting for demographics and seasonal changes--there were small but significant monthly increases in GP events, hospital admissions, emergency attendances, for the persistent pain cohort. Outpatient attendances showed small but statistically significant month-on-month decreases. Findings may point to unmet need in accessing specialist care, particularly among older adults and individuals from more deprived areas. Patterns of pain prevalence and service use reflect existing inequalities across age, sex, and socioeconomic status. There is a need for further research, service improvements and policy development. Funding statementThe authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.