Social dimensions as explanatory approaches for the development of chronic pain: a meta-ethnography of qualitative...

Chronic non-malignant pain - especially low back pain and headache disorders - is an increasingly common condition affecting many people globally. The biopsychosocial model of pain is widely used in the field of chronic pain research and considers the complex etiologies of chronic pain. Although the biopsychosocial model is well accepted, most studies address biomedical and psychological aspects, while neglecting the social dimension. The aim of our meta-ethnography was to systematically collect and analyze qualitative studies that explored social dimensions as explanatory approaches for chronic pain onset and progression. We used meta-ethnography guidelines and conducted systematic searches in three databases (PubMed, Web of Science, CINAHL) in November 2023, and an update in November 2024. Critical appraisal of included studies was performed using the JBI critical appraisal checklist for qualitative research. We included twenty-seven studies and developed eight categories of social dimensions that contribute to explaining chronic pain. These third order constructs were gender relations and gender inequity, stigmatization, discrimination, and marginalization based on social identity, adversities, harsh living and working conditions, high expectations regarding work or school, cultural and religious beliefs and values, loneliness, and lifestyle factors. Our findings help confirm that there are relevant social dimensions that contribute to the chronicity of pain. Addressing these dimensions is necessary for adequate understanding of chronic pain's complexity and preventing chronic pain onset and progression.