How Does Place of Residence Influence the Experience and Management of Chronic Non‐Malignant Pain? A Systematic Review

BACKGROUND AND OBJECTIVE: Chronic non-malignant pain (CNMP) affects up to half of the UK population and one third of adults globally. Rural populations experience poorer health outcomes across several chronic conditions; however, the influence of place of residence on CNMP management, outcomes and experiences remains unclear. This systematic review examined how place of residence (urban or rural) impacts CNMP management, outcomes and experiences. METHODS: PubMed, psycINFO, Medline, Embase and CINAHL databases were searched for qualitative and quantitative studies. Dual title/abstract screening and full-text review were undertaken against pre-defined inclusion/exclusion criteria. A narrative synthesis was performed. RESULTS: Of 2341 titles screened, 16 studies were included (12 observational, three qualitative and one mixed-methods study). Most studies were rated as fair quality, with limitations including unsatisfactory response rates and non-validated outcome measures. Rural residents were more likely to use primary care and opioid-based treatments, whereas urban residents had greater access to specialist pain services. Outcomes were less consistent; several studies reported poorer pain-related outcomes among rural residents, although some identified no significant differences compared with urban populations. Long travel distances, prolonged waiting times and limited specialist and non-pharmacological services were barriers to care. CONCLUSIONS: This review highlights geographic inequalities in CNMP management and experiences. Findings should be interpreted in light of methodological limitations and study heterogeneity. Targeted approaches are needed to improve equitable access to pain management across settings. SIGNIFICANCE STATEMENT: This systematic review synthesises evidence on how geographic location influences the management, outcomes and experiences of people with chronic non-malignant pain. The findings identify consistent rural-urban disparities in access to evidence-based pain care and highlight important gaps in the current literature, including the limited availability of high-quality comparative studies. These findings provide a foundation for future research and inform the development of more equitable pain services. TRIAL REGISTRATION: PROSPERO number: CRD42024522734.