Benz T.1,2, Lehmann S.3, Brioschi R.4, Elfering A.2, Aeschlimann A.3, Angst F.3
1Rehabilitation Clinic “RehaClinic”, Research Department / Pain Center, Bad Zurzach, Switzerland, 2University of Bern, Institute of Psychology, Bern, Switzerland, 3Rehabilitation Clinic “RehaClinic”, Research Department, Bad Zurzach, Switzerland, 4Rehabilitation Clinic “RehaClinic”, Pain Center, Bad Zurzach, Switzerland
Background: Available evidence shows that perception, coping, and treatment of pain varies among different populations and cultural regions. In particular, it is unknown how much immigrants in Western European countries profit from pain management programs, which have been established and evidence-based on and for the native population.
Purpose: The primary aim of this study was to detect differences in the course of Italian- and German-speaking patient's state of health and quality of life after a standardized interdisciplinary pain program, which have the same structure and therapy entities, but are specifically mediated in German or in Italian.
Methods: The prospective cohort study with 61 Italian-speaking and 63 German-speaking patients measured health-related quality of life, pain, fear and depression comparing at baseline, after 4 weeks of pain program and at 1 year follow-up. Differences between the two groups were tested on significance by generalized estimation equations (GEE). This method modeled changes of health by multivariate logistic regression adjusting for sex, education, number of comorbidities and the baseline score over both follow-ups for each scale.
Results: Italian-speaking patients (n=61) showed higher proportions of males, lower educated and less burdened by comorbidities than German-speaking patients (n=63). At baseline, physical and psychosocial health, depression and fear of the Italian-speaking patients were worse than German-speaking patients, with the exception of less pain in the Italian-speaking patients on the SF-36. Changes of health showed more improvement in German- than in Italian-speaking patients on all scales and at both follow-ups. In GEE, the highest differences were observed in SF-36 physical functioning (p=0.035), HADS anxiety (p=0.038) and HADS depression (p=0.023). On SF-36 bodily pain, the difference was also present but not significant (p=0.166).
Conclusion(s): This study detected that short- and midterm outcome of Italian-speaking patients was worse than that of German-speaking patients, even after adjustment for baseline differences.
Implications: The reasons for this studys results remain unclear, but may have consequences for future management of Italian-speaking patients in interdisciplinary pain management programs. Considering language as a proxy for acculturation, this supports the hypothesis that patients with lower level of acculturation may have special needs in therapeutic management. A cultural sensitive approach in a multidisciplinary pain program might enhance the positive outcome in the short- and mid-term.
Funding acknowledgements: This study was supported by the Zurzach Spa Foundation, Bad Zurzach, Switzerland.
Topic: Pain & pain management
Ethics approval: This observational project was approved by the Local Research Ethics Committee of the Health Department in Aarau, canton Aargau, Switzerland.
All authors, affiliations and abstracts have been published as submitted.
