Biopsychosocial and Cultural Determinants of Functioning and Healthcare Outcomes in Chronic Non-Cancer Pain: An...

Background: Chronic non-cancer pain (CNCP) is an increasing global health concern and a multidimensional condition shaped by biological, psychological, social, and cultural factors, with impacts on functioning, quality of life, and healthcare. However, evidence remains fragmented, limiting integrated understanding and care. Objective: This study aimed to synthesize and critically analyze existing evidence on the biological, psychological, social, and cultural dimensions characterizing individuals with CNCP, and their impact on functionality, quality of life, and healthcare. Methodology: An integrative review was conducted following the Whittemore and Knafl framework. Searches were performed in Medline, Cumulative Index of Nursing and Allied Literature Complete (CINAHL), PsycINFO, Scopus, Web of Science, and grey literature in English and Spanish, without time restrictions. Studies were screened using predefined eligibility criteria and appraised with Joanna Briggs Institute tools. Data were systematically extracted and synthesized using thematic analysis to identify key attributes of people living with CNCP. Quantitative findings were summarized descriptively and mapped to thematic domains, while qualitative data were analyzed interpretively. Both evidence streams were integrated through convergent thematic synthesis. Results: Forty-four studies were included, predominantly cross-sectional and observational. Five themes emerged: biological aspects; functioning and quality of life; psychological and mental factors; social support and peer relationships; and social and gender determinants. CNCP was consistently associated with multimorbidity, sleep disturbance, psychological distress, and maladaptive coping, contributing to reduced functional capacity, greater disability, poorer quality of life, and increased healthcare utilization. Socioeconomic disadvantages and environmental constraints were linked to higher pain burden, whereas resilience and social support emerged as protective factors mitigating functional and psychosocial impact. Conclusions: Evidence largely concentrates on biomedical, functional, and psychological dimensions, whereas social determinants and healthcare quality remain comparatively underexplored. Broadening these perspectives is essential to inform public health strategies and support multidisciplinary, equitable care for individuals living with CNCP.