Social Prescribing and community activities for people living with chronic pain: A Realist Synthesis

Chronic pain is associated with significant physical and mental health burden to individuals and society. Social determinants of health are associated with an increased prevalence of chronic pain and disability. Social prescribing is an intervention designed to address social determinants of health; however, little is known about how social prescribing can support people living with chronic pain (PECP). To investigate the mechanisms and contexts by which participation in social prescribing and/or community activities lead to health and wellbeing outcomes in PECP. A realist synthesis was conducted in November 2024 and updated in March 2026. Context-mechanism-outcome configurations (CMOCs) were produced and mapped to the Multi-Level Mechanisms of Leisure Framework to identify potential psychological, biological, social and behavioural mechanisms. A programme theory was developed to illustrate how and why social prescribing interventions lead to health and wellbeing outcomes in PECP. Of 9761 studies, 35 were included. Four sources explored social prescribing link worker models and thirty-one investigated individual community activities. 15 overarching CMOCs were identified including seven psychological, three biological, three social and two behavioural mechanisms. The CMOCs highlight how creative, cultural and leisure activities, social prescribing pathways and volunteering, lead to intended and unintended outcomes (such as pain resulting in reduced participation in volunteering). This synthesis provides evidence for how social prescribing interventions lead to improved health and wellbeing in PECP and can be used to inform non-clinical service provision, especially where access to pain services is limited.