Shifting the distribution of risk for high-impact chronic pain: Targets for population-level interventions

High-impact chronic pain significantly affects quality of life and poses burdens on healthcare systems. Public health strategies that shift modifiable risk factors at the population level may reduce its impact. A cross-sectional analysis was conducted using a population intervention model to estimate how changes in physical activity and body mass index might affect prevalence of high-impact chronic pain, using data from 166,926 UK Biobank participants. High-impact chronic pain was defined by the presence of chronic pain along with reduced health-related quality of life, measured using the Euroqol EQ-5D-5L instrument. The effects of shifts in risk factors varied across different levels of confounder adjustment were assessed. Increasing vigorous physical activity by two days per week and 20 min per session was associated with a reduction in high-impact chronic pain prevalence from 18.1% to 16.7% after adjusting for socio-demographic factors, and to 17.6% after further adjustment for comorbidities. A reduction in body mass index of 7% was associated with a reduction in high-impact chronic pain prevalence from 18.9% to 16.8% (unadjusted) and to 17.5% after full adjustment. Effects were consistent across subgroups defined by age, sex, and socioeconomic deprivation. These results provide estimates of how targeted population shifts might impact the prevalence of high-impact chronic pain, based on observed associations. This could help inform the development of public health strategies that promote physical activity and healthy weight at the population level to address the burden of high-impact chronic pain. PERSPECTIVE: This study estimates how population-wide changes in physical activity and BMI could reduce the prevalence of high-impact chronic pain. The findings support public health approaches that address shared environmental and social risk factors, rather than individual-level interventions.