HMN 2026: How Not everyone has equal access to pain rehabilitation

Chronic pain can affect work, everyday life and quality of life. Patients with chronic pain do not have access to specialized rehabilitation on equal terms. Education, age, sex and region of birth appear to play a role, particularly in combination, according to a study from the University of Gothenburg published in the Scandinavian Journal of Pain.

The study is based on 39,346 patients who were referred to specialized pain care in Sweden between 2009 and 2016. Nearly half of these patients (49.8%) were assessed as able to participate in a rehabilitation program. The study identifies several factors that appear to influence which patients gain access to specialized pain rehabilitation.

Individual factors

Among women, 52.1% were assessed as able to participate in specialized pain rehabilitation, compared with 44.1% of men. Among patients born in the Nordic countries, the proportion was 51.2%, compared with 44.7% among patients born outside the Nordic countries. Education also appeared to matter: 40.2% of patients with only compulsory education were assessed as able to participate, compared with 54.9% of patients with a university education.

Age also played a role. Middle-aged patients were more often assessed as able to participate than both younger and older patients. The fact that the youngest patients participated less often than middle-aged patients was unexpected, since early interventions can be important both for individuals and society.

The study is part of Helene Svensdotter’s doctoral education. She is a physiotherapist at Regionhälsan and a doctoral student at the Sahlgrenska Academy, University of Gothenburg.

“We see that the differences are not only linked to individual factors. It is the combination of factors such as educational level, age, sex and region of birth that appears to influence the likelihood of gaining access to rehabilitation. This makes the findings important to consider when health care services review both assessment procedures and the types of interventions available to different patient groups.”

Several factors at the same time

When the researchers analyzed several factors simultaneously, the differences became more pronounced. The lowest likelihood of being offered pain rehabilitation was found among patients with a combination of primary school education and being born outside the Nordic countries, with similar patterns observed among women and men regardless of age. The highest likelihood was found among middle-aged women with a university education, regardless of whether they were born within or outside the Nordic region.

The researchers point to several possible explanations for these differences, including language-related factors, life circumstances, the ability to participate in an extensive rehabilitation program, health care professionals’ assessments of patients’ conditions and circumstances, and perceptions of who is considered suitable for rehabilitation.

The findings can be used to further develop how patients are assessed before specialized pain rehabilitation and how different types of support can be adapted. The aim is for more patients with chronic pain to receive the right intervention, regardless of their background.

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