In a large European survey, 19% of adults reported moderate to severe chronic pain and 40% considered their care inadequate. The absence of a striking abnormality on imaging does not make the pain any less real.
If pain persists despite consultations or tests already carried out, Noria Health Hub can arrange a full check-up or a second medical opinion in Brussels, with a report within 24 h, coordinate your care where needed across more than 40 medical pathways in 48 h, then, if your medical condition allows, arrange surgery within 7 days.
The key figures
| What is measured | The figure | Source |
|---|---|---|
| European adults reporting moderate to severe chronic pain for at least 6 months | 19%, across 46,394 respondents in 16 countries | European Journal of Pain, 2006 |
| Share who consider their pain inadequately managed | 40%. And only 2% are seen by a pain specialist | European Journal of Pain, 2006 |
| Share diagnosed with depression because of the pain, and share who lost their job | 21% and 19% | European Journal of Pain, 2006 |
| Prevalence in France of moderate to severe chronic pain | 19.9% of adults, about 12 million people | Pain, 2008, cited by the French health authority in 2023 |
| Access time to a specialist pain service in France | 8 months or more for a first consultation, after an average of 5 years of symptoms. Fewer than 3% of patients reach one | French health authority, 2023 |
What waiting is associated with, without proving causation
This is where precision matters most, because this is where shortcuts cost most.
| The study | What it finds | The caveat it must be quoted with |
|---|---|---|
| Systematic review of 24 studies, 2008 | Significant deterioration in health-related quality of life and psychological wellbeing during 6 months of waiting. A wait of 6 months or more is judged medically unacceptable | The authors write that it is not known when the deterioration begins, and that the effect of waiting on treatment outcome remains to be determined |
| Registry of 3,230 patients, 2020 | Only patients who waited less than 2 months reach a clinically important improvement at 6 months | The authors state that the differences between groups are not clinically significant. Quoting the first half without the second would be dishonest |
| Cohort of 339 patients followed up to 30 months of waiting | Indicators stable for the first 6 months, then long-term deterioration. Medication use rises without relief following | The deterioration is not linear, and it does not appear immediately |
| Cohort of 211 patients assessed at 0, 3 and 6 months, 2025 | Depression, anxiety and catastrophising remain at clinically severe levels throughout the wait | They are persistent rather than rising. The defensible message is that waiting leaves people in severe distress without care, not that every month mechanically worsens things |
And this must be added. No randomised trial assigns patients to wait longer or shorter, that would be ethically unacceptable. The link between waiting and worsening is plausible and consistent, it is not demonstrated experimentally. We will never present it otherwise.
How long people actually wait
| Country | What is measured | The wait |
|---|---|---|
| United Kingdom | Care pathways waiting, November 2025 | 7.3 million pathways. 61.8% treated within 18 weeks, against a 92% standard. Median 12.9 weeks, and 156,483 people beyond 52 weeks |
| Canada | From family doctor referral to treatment, 2025 | 28.6 weeks median, against 9.3 weeks in 1993. 49.9 weeks in neurosurgery |
| France | Access to a specialist pain service, 2023 | 8 months or more, with no published distribution and no update |
The British figure comes from an exhaustive administrative file, the Canadian one from a declarative survey of physicians with a 13.1% response rate. They do not compare directly.
Opioids: when the risk of prolonged use rises
Across 1,294,247 patients who had never received an opioid, the probability of still being on one a year later is 6.0%, and 2.9% at three years. The sharpest rises in the risk of prolonged use appear after the 5th day of treatment, then after the 31st, and from the second then the third prescription.
This is not an argument against opioids, it is an argument against letting pain settle without assessment. The risk is built in the first days of prescribing, not the last.
Multidisciplinary care: a real but modest benefit
| What is compared | The result |
|---|---|
| Multidisciplinary rehabilitation against usual care, 41 trials, 6,858 participants | Pain reduction equivalent to about 0.5 points on a 10-point scale. Moderate certainty |
| Return to work at 1 year, against physical treatments alone | Odds multiplied by 1.87 |
| Return to work at 1 year, against usual care | 1.04, not significant |
| Duration of the benefit | Appreciable in the short and medium term, it collapses beyond 12 months |
Multidisciplinary care therefore delivers a measurable benefit, but generally a modest one. The data do not allow it to be presented as a lasting transformation of chronic pain.
Second opinion before spinal surgery: the evidence is still thin
This is the most frequent request in the field, and the literature is weaker than people think. A scoping review of 12 studies finds agreement between first and second opinion on the need to operate ranging from 0% to 83% across studies, and 11 of those 12 studies are of low methodological quality. None is randomised.
The striking figures do exist. A German programme confirmed the surgical indication in only 15 of 522 patients, 2.9%, and 18% of the sample recontacted had eventually been operated on 2 years later. A Brazilian programme covering 1,088 patients recommended conservative treatment for 60.8% of them. But these programmes only recruit patients who already doubted their indication, and the rate is not generalisable.
What the studies do not allow anyone to claim
You will not read here that every month of waiting mechanically worsens chronic pain, because the data show persistent distress rather than linear worsening, and because causality is not established. We will not claim that a second opinion avoids one surgery in two, because the real range runs from 0% to 83% and because it is unknown whether patients forgo the operation or merely postpone it.
What we do say, and it is documented, is that a wait of 6 months or more is judged medically unacceptable by the literature itself, and that a great many people are enduring exactly that today.
In practice, if this concerns you
You set out your problem, your symptoms or your question. Any reports, laboratory results and images already available can be reviewed before you arrive, so that the pathway is prepared. The aim is not to run every possible test, but to select those that can genuinely help confirm a hypothesis, rule out a risk or guide a decision. The findings are brought together and the next steps are organised. Follow-up is then coordinated.
Need medical advice quickly? For a concern that does not call for the emergency services, you can ask to speak to a doctor at any time through Noria Health Hub. This on-demand medical consultation is billed separately from the assessment pathway.
Further reading
The companion articles.
Waiting” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/what-delay-really-costs-what-the-studies-say/”>Waiting for a diagnosis or a treatment, what the studies actually measure
How” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/how-we-build-a-health-assessment/”>How we build a health assessment
Sources
Breivik H et al., Survey of chronic pain in Europe, prevalence, impact on daily life, and treatment, European Journal of Pain, 2006. https://doi.org/10.1016/j.ejpain.2005.06.009
Bouhassira D et al., Prevalence of chronic pain with neuropathic characteristics in the general population, Pain, 2008. https://doi.org/10.1016/j.pain.2007.08.013
Haute Autorité de santé, Parcours de santé d’une personne présentant une douleur chronique, janvier 2023.
Lynch ME et al., A systematic review of the effect of waiting for treatment for chronic pain, Pain, 2008. https://doi.org/10.1016/j.pain.2007.06.018
Deslauriers S et al., The association between waiting time and multidisciplinary pain treatment outcomes, BMC Rheumatology, 2020. https://doi.org/10.1186/s41927-020-00157-0
Burke ALJ, Mathias JL, Denson LA, Waiting for multidisciplinary chronic pain services, Journal of Health Psychology, 2020. https://doi.org/10.1177/1359105317752828
Tidmarsh LV et al., The persistence of psychological distress while waiting for pain management, British Journal of Pain, 2025. https://doi.org/10.1177/20494637251377761
NHS England, Consultant-led Referral to Treatment Waiting Times, November 2025. https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/
Fraser Institute, Waiting Your Turn, Wait Times for Health Care in Canada, 2025. https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2025
Shah A, Hayes CJ, Martin BC, Characteristics of initial prescription episodes and likelihood of long-term opioid use, MMWR, 2017. https://doi.org/10.15585/mmwr.mm6610a1
Kamper SJ et al., Multidisciplinary biopsychosocial rehabilitation for chronic low back pain, BMJ, 2015. https://doi.org/10.1136/bmj.h444
Gianola S et al., Multidisciplinary biopsychosocial rehabilitation, the need to present minimal important differences, Health and Quality of Life Outcomes, 2018. https://doi.org/10.1186/s12955-018-0924-9
Ferreira GE et al., Second opinions for spinal surgery, a scoping review, BMC Health Services Research, 2022. https://doi.org/10.1186/s12913-022-07771-3
Lindena G et al., Zweitmeinung bei Wirbelsäulenoperationen, Der Schmerz, 2023. https://doi.org/10.1007/s00482-022-00656-8
Antonioli E et al., Second opinion program on spine surgeries, BMC Health Services Research, 2023. https://doi.org/10.1186/s12913-023-10405-x
da C Menezes Costa L et al., The prognosis of acute and persistent low-back pain, a meta-analysis, CMAJ, 2012. https://doi.org/10.1503/cmaj.111271