Reply to Armfield and Sterling

We thank Dr. Armfield and Prof. Sterling for their thoughtful commentary on our systematic review on the prevalence and associated sociodemographic and clinical features of chronic pain across Europe7 and for underlining the critical role of modifiable risk factors and prevention. Although we focused primarily on prevalence estimates and descriptive comorbidity patterns, we fully agree that the next step in research must go beyond the concurrent associations of these variables. Causal modeling and preventive concepts must be considered in shaping public health policies and clinical strategies that reduce the burden of pain-related suffering and disability.