Making underrepresented pain visible: Chronic pain disparities among immigrant adolescents in 30 European countries

Chronic pain is prevalent among adolescents and is associated with significant impairments in physical, emotional, social, and academic functioning. Despite advances in pediatric pain research, including efforts to improve diagnosis and management, critical gaps remain in understanding pain disparities among subpopulations. Immigrant adolescents represent a particularly overlooked group. While Europe hosts more than one-third of the global migrant population, epidemiological data on chronic pain in immigrant adolescents remain scarce and inconsistent. This study examined chronic pain prevalence and differences between immigrant and non-immigrant adolescents in Europe. Cross-sectional data from the 2018 Health Behaviour in School-aged Children study (n=146,187), including nationally representative samples of 11-, 13-, and 15-year-olds from general schools in 30 countries, were used. Chronic pain, defined as daily pain for at least six months, was assessed via self-report. Cross-national age- and gender-standardized prevalences were calculated, and log-binomial regressions examined differences between immigrant and non-immigrant adolescents. Overall, 14% of immigrant adolescents reported chronic pain, compared to 12% of non-immigrants. Significant variations were observed across countries, with chronic pain rates ranging from 7% in Estonia to 31% in Bulgaria. Immigrant adolescents reported significantly higher chronic pain rates in eight countries, particularly in Central and Eastern Europe. This study shows that chronic pain is disproportionately prevalent among immigrant adolescents in several European countries. Policymakers should prioritize comprehensive integration programs, inclusive health care, and culturally responsive care to address inequities and mitigate the burden of chronic pain in this population. PERSPECTIVE: This study reveals significant disparities in chronic pain among immigrant adolescents living in Central and Eastern European countries. By identifying a vulnerable and underrepresented group, these findings underscore the need for inclusive health policies and offer a foundation for future research on sociocultural mechanisms contributing to pediatric chronic pain inequities.