Introduction Health inequalities continue to exist for individuals from an ethnic minority background who live with chronic pain. There is a growing recognition that an individual’s experience of pain is shaped by their cultural beliefs, which may influence their decisions about managing their pain. Aims This service evaluation aimed to (a) understand experiences of service users from a Black, Asian or other ethnic minority background of being invited to and attending a group pain programme in one secondary care pain rehabilitation service. (b) Provide recommendations to develop culturally grounded services to better meet the diverse needs of all service users living with chronic pain. Method Semi-structured interviews were conducted with five service users who had been offered a place on a group pain programme within the last 3 years. The interviews were recorded and transcribed verbatim. An interpretative phenomenological analysis was used to identify themes in the data. Results The analysis produced three themes (1) Pain, Ethnicity and Coping: Perceptions of pain and coping in relation to ethnicity and intersectional factors, alignment to a self-management approach. (2) Communication for Decisions: Experiences of ethnicity and culture in relation to health professional communication about group pain programmes, participants’ expectations and fears. (3) Feeling Included: Experiences of feeling included or excluded in group pain programme, relationships and empowerment during the group pain programme. Discussion The five service users shared a range of perspectives on how they felt ethnicity shaped their experience of the group pain programme. The findings suggest that adaptations to group pain programmes can make a meaningful difference for service users from ethnic minority backgrounds. 10 recommendations are suggested, including greater exploration of cultural beliefs during assessment, improving accessibility of information about the service and engaging more diverse attendees and facilitators.

Of all the distinctive features of the Buddhist religion, one of the most neglected is the sangha. Scholars give much attention to the study of texts and commentaries, the analysis of doctrines and the classification of schools. But the core of the Buddhist religion is the sangha, the community ofbhikkhus around whose corporate life the religion is moulded. It is the existence and structure of the sangha which has shaped the history of Buddhism, enabled it to take root in new countries, and given it the customs and rituals which have made it a religion rather than a small sect.The sangha is sometimes described as an entirely selfish organisation, the gathering together of those who are concerned with the realisation of nibbdna, the extinguishing of their own desires and the cessation of the series of rebirths of which their present life is one member. This is of course one aspect of the sangha. It enables those who are searching for the supreme goal to live free from the distractions of family life and responsibility. But there is another aspect of the sangha. It exists for those who are not its members, for the mass of the people who are referred to in the Pali canon as bahujana. This word is used by a later commentator, Buddhaghosa, to mean 'the unconverted', but in earlier texts it means 'the community as a whole'. One task of the sangha is to make known among the bahujana the teachings which spring from the Buddha. The word used for this spread of the teachings is the adjectival form bdhujanna. The religion must become spread among the people (bdhujannam), and the instrument for achieving this expansion is the sangha. In different periods the sangha played this role in different ways, sometimes self-consciously undertaking a missionary obligation, sometimes unconsciously becoming the focal point of popular customs. This article describes how the sangha has played this role within the Theravada tradition of India and Ceylon.