Chronic pain influenced by social background

Nov 16 2004

Griffith University research has shown that recovery from chronic pain is heavily dependent on the socio-economic status of the patient, rather than the nature of the healthcare they receive.

Ms Lynette Guy, a physiotherapist and PhD student in Griffith’s School of Public Health, said communication with health professionals was also important in shaping how patients adjusted to an injury.

As part of her PhD research, Ms Guy conducted in-depth interviews and focus group discussions with about 40 staff and 40 patients from a multidisciplinary pain clinic in New South Wales. Most of the patients had been living with persistent and unrelenting pain for between two and 10 years.

She found patients with ongoing pain from a musculoskeletal injury tended to fall into one of three groups.

Those who do best after a work-related injury or car accident tended to be those in the higher socio-economic groups. However the effect is not simply driven by access to financial resources and better health care.

“They receive the same treatment as other patients but they are better able to self-manage their situation. For example, they are empowered by having greater choice over finding other treatment and rehabilitation options, and are more able to find other jobs and regain an income.”

Ms Guy said a second group of patients became disillusioned and disempowered by the health system when interventions failed to reduce their pain. This group did not have the resources to seek other help or support.

“Many of the treatments actually make the patients feel worse. For example, medications designed to relieve pain can create secondary effects such as stomach ulcers. Nerve blocks offer temporary relief but the effect wanes with repeated treatment.”

For another group of the patients, seeking justice through compensation and litigation became their main priority. Many developed a sense that treating practitioners, solicitors and insurers did not believe their story and their symptoms.

It was suggested that improved communication and early settlement of claims could help these people get on with their lives sooner.

Ms Guy said the ‘no pain - no gain’ model of care also disadvantaged many patients. By pushing patients to increase their level of activity too early, some health professionals were causing more pain. This increases the sensitivity of their nervous system.

While health professionals often defined a successful outcome as a return to work, she found patients tended to focus more on the disruption that having pain had caused to their life, to their loss of self-identity, and how others treated them.

Ms Guy said there had to be better support structures for injured people from lower socio-economic backgrounds. Greater awareness of how interactions with treating practitioners can influence patient outcomes is also recommended. Those who are unable to cope with the effects of their pain are likely to become dependant on social security benefits and remain unemployed.