Preventable deaths in people with a chronic pain condition: a systematic case series of coroners’ reports in England and Wales (protocol)
Creators: name: Richards, Georgia C.
name: Webb, Stephanie
Publisher: name: OSF Registries
Year: 2024
Subjects: subject: Clinical Epidemiology
subject: Public Health
subject: Medicine and Health Sciences
subject: Epidemiology

description: Chronic pain is pain that persists or recurs for more than 3 months (Treede et al., 2019). It is estimated that 35% to 51% of adults in the UK experience chronic pain (Fayaz et al., 2016). In 2016, pain and pain-related diseases were graded as the main cause of disability and disease burden globally, with neck and lower back pain being the leading cause of disability (GBD 2016 Disease and Injury Incidence and Prevalence Collaborators, 2017). A systematic review has found that people with chronic non-cancer pain had a 30% greater mortality rate than those without pain (Webb et al., 2024). However, as mortality statistics are not routinely reported for people that had a diagnosis of chronic pain, it’s been difficult to understand its impact on life expectancy and causes of death.

People with chronic pain may be offered various interventions which have varying levels of benefits and harms, including death. The National Institute for Health and Care Excellence (NICE) guidelines suggest assessing the person with chronic pain holistically and offering a range of management options including physical activity, psychological therapy, and acupuncture (NICE, 2021). Despite these recommendations, analgesics such as opioids are often used, which provide minimal benefits for most people with chronic non-cancer pain (Hylands‑White, Duarte and Raphael, 2017). Moreover, the use of opioids has increased the risk of all-cause mortality in people with chronic pain (Häuser et al., 2020). Surgery can also be offered for people with chronic pain. However, procedures are risky, and pain usually returns within six to 12 months (Kanpolat, 2004; Hylands‑White, Duarte and Raphael, 2017). Therefore, understanding the causes of deaths in people with chronic pain will improve the evidence on the safety of treatment and management strategies for those living with chronic pain.

In England and Wales, the coronial system has legislation that mandates coroners to write a report if they believe that a death could have been prevented and to communicate their reports to individuals or organisations that have the power to act. Such reports, previously called Rule 43 and now named Prevention of Future Death reports or PFDs, have been made openly available since July 2013 on the Courts and Tribunal Judiciary website. When an individual or organisation receives a PFD report, they are required to respond to the coroner within 56 days to outline actions proposed or taken to address the coroner’s concerns. These reports have been used to assess a range of deaths including deaths involving medicines, products, and other healthcare-related events (Bremner et al., 2023).

Our research group has developed a novel platform, the Preventable Deaths Tracker (https://preventabledeathstracker.net/), to collate all available PFDs. We have used this database to conduct six systematic retrospective case series of coroner PFDs, including an assessment of preventable deaths during the covid-19 pandemic, preventable deaths involving cardiovascular disease, and preventable deaths involving medicines, including opioids (Anis et al., 2022; Aronson, Ferner and Richards, 2022; Dernie et al., 2022; Swift et al., 2022; Zhang and Richards, 2023). Our research has found that PFDs hold important information that is under explored. Importantly, the concerns highlighted by coroners in PFDs exhibit a wide variety of issues that urgently require addressing. To date, no investigation of PFDs in people that had chronic pain has been conducted.