To describe and investigate the relationships between illness perspectives, activation levels, coping strategies and pain management outcomes among a socially and culturally diverse sample of adults living with chronic pain and undergoing pain management.
A convergent parallel mixed-method study involving consecutive adults with non-malignant pain (>6 months) attending a tertiary pain clinic over an 18-month period in 2022-23. Consenting participants completed routinely collected questionnaires capturing socio-demographic information, comorbidities, pain and psychological symptoms (Brief Pain Inventory; Depression, Anxiety and Stress Scale), pain-related cognitions (Pain Catastrophising Scale) and additional measures capturing illness beliefs (Brief Illness Perceptions Questionnaire), activation using the Patient Activation Measure, pain related coping (Brief-cope) and the Beliefs about Medicines Questionnaire. A purposive sample of participants from diverse cultural backgrounds, and varying illness beliefs, activation levels and symptom profiles were invited to participate in a subsequent semi-structured (qualitative) interview exploring their illness perspectives and pain management behaviours conducted in their preferred language and audio-recorded for transcription. Data were analysed using a combination of multivariate and inductive thematic analyses to examine the relationships between minority cultural identification, illness beliefs, activation levels and pain profiles.
180 patients consented and completed quantitative data, 58% of whom identified with an ethnic minority community. There were significant differences between ethnic minority participants and the wider cohort with ethnic minority participants displaying significantly higher pain severity (p0.001), more negative illness perceptions (p=0.012), greater psychological symptoms (depression p=0.014; anxiety and stress p0.001), and lower levels of activation (p=0.036). Hierarchical multiple regression analysis, controlling for demographic and pain duration, revealed ethnic minority identification and patient activation levels, but not illness perceptions, predicted pain intensity. Qualitative interviews with 30 participants highlighted prominent biomedical causative beliefs across the cohort with cross-cultural differences emerging regarding treatment (avoidance versus resilience orientation) and prognostic approaches (identity disruption versus acceptance), underpinned by individual perspectives of the personal burden of persistent pain.
Understanding the influence of cultural identification and activation for pain management on pain symptoms and related disability may help tailor treatment approaches towards features contributing to a higher burden of pain among these communities.
Cultural identification influences illness beliefs and pain management behaviours
- Assessment for the sociocultural influences on chronic pain should be incorporated in chronic pain assessment.
- Approaches that tailor treatment to the individual, social and ethnocultural factors that influence pain warrant further exploration to reduce inequity in pain management.
Culture
Inequity
