What is the background to this research?
Chronic pain is a major public health problem, with many people experiencing high-impact chronic pain that limits their work, social activities, and daily life. While we know that factors like physical activity levels and body weight influence chronic pain risk, most prevention efforts focus on treating high-risk individuals one at a time. However, when health risks exist on a continuum across the entire population (meaning everyone has some risk from very high to very low), we need to think differently. Despite chronic pain being recognized as a public health priority, population-level prevention strategies remain underexplored.
What did we seek to find out?
We wanted to estimate how small changes in physical activity and body weight across entire populations might reduce the overall burden of high-impact chronic pain. Rather than focussing on individual treatment, we examined how shifting risk factors at the population level could produce benefits.
What did we do?
This was a modelling exercise using data from nearly 167,000 UK Biobank participants. We created "what if" scenarios to estimate how HICP rates might change if:
- Everyone increased their physical activity by modest amounts (e.g., adding two days of vigorous activity per week and 20 more minutes per session)
- The whole population achieved small reductions in body mass index (ranging from 1% to 7% of current BMI)
We used statistical methods to predict the prevalence of HICP under these hypothetical scenarios, accounting for factors like age, sex, income, and existing health conditions. It's important to understand this was not a clinical trial but a statistical model projecting potential population-level impacts.
What did we find?
Our modelling showed how population-wide changes could reduce chronic pain burden:
- If the population increased activity with one day each of walking, moderate, and vigorous per week and 10 minutes per session, HICP prevalence could fall from 18.1% to 17.4%.
- A 7% reduction in BMI across the population was associated with HICP prevalence dropping from 18.9% to 17.5% after accounting for other health factors.
Benefits were seen across all groups - men and women, different age groups, and all socioeconomic levels. While a 1-2 percentage point reduction might seem small, at a population level this translates to hundreds of thousands fewer people living with debilitating chronic pain.
Why does this research matter?
This research illustrates a fundamental principle: when health conditions exist on a continuum of risk, the appropriate unit for intervention is the population, not the individual. Treating only high-risk individuals won't address the underlying causes. Our modelling suggests how public health strategies could complement clinical care and potentially prevent many cases of high-impact chronic pain. Strategies could include policies and environmental changes that make healthy choices easier for everyone, such as walkable environments and making healthy foods affordable. While this is a modelling exercise and not proof of real-world cause-and-effect, it provides evidence for the potential scale of benefit from population-level approaches.
Who funded this study?
This project was funded by UK Research and Innovation (UKRI) and Versus Arthritis as part of the Advanced Pain Discovery Platform (Grant Ref: MR/W026872/1), with additional support from the Medical Research Foundation and Eli Lilly and Company Ltd. The funders had no role in study design, analysis, or interpretation.
Where can I read more?
The full scientific article is available at: https://www.jpain.org/article/S1526-5900(25)00800-4/fulltext