Pain behaviour in young immigrants having chronic pain: an exploratory study in primary care

Abstract

Pain behaviour can hamper rehabilitation. The aim of this study was to explore the phenomenon of pain behaviour in an unselected group of immigrant patients on >6 weeks of sick leave before and after a transcultural treatment programme in primary care. Anxiety about pain and pain behaviour-i.e. > or = 1.5 points on the University of Alabama in Birmingham (UAB) scale with scores of 0-10-were noted before and after treatment. The sex-adjusted odds ratios (OR) for pain behaviour, before and after the treatment, were calculated using logistic regression with 95% confidence intervals (95% CIs). Forty-nine men and 102 women having a mean age of 38 years participated. Their mean sick leave was 46 weeks. All reported psychosocial stress, one-quarter were depressed and social functioning was generally low. The pain was mostly caused by muscular insertion lesions (entesopathies). The frequency of pain behaviour and anxiety about pain declined after treatment (from 68% to 54% and from 76% to 50% respectively). Duration of full-time sick leave and among men also decreasing social functioning were correlated with the UAB score. Those who reported persistent anxiety about pain, or men who were depressed, had higher scores. Only persons on full-time sick leave >1 year had a significant OR for pain behaviour before treatment (OR 3.23; 95% CI 1.17-8.85, adjusted for sex). After treatment, only persons reporting persistent anxiety about pain showed a significant OR for pain behaviour (OR 3.05; 95% CI 1.49-6.23, adjusted for sex). In conclusion, pain behaviour was common in this group of immigrant patients < or = 45 years of age on long-term sick leave. Anxiety about pain and full-time sick leave for more than 1 year significantly predicted pain behaviour.

Work performance and pain intensity during exercise. A before-and-after study of a cognitive-behavioural treatment in primary care of young immigrant patients

“…In this study both anxiety and behaviour decreased, to 25 and 36% respectively, compared with the about 50% outcome values in a previous study with similar frequencies at the start. 20,21 We categorized the subjects according to education because, in clinical practice, women with no or very little education seem not to benefit from any physiotherapeutic interventions 17 (personal report) and there were also no differences between sub-groups categorized by job, marital status, number of children or type of disorder. This study shows that having little education may predict little results from exercise treatment in the view of the physiotherapist.…”

“…21,44 A encouraging result here was that reported pain anxiety declined to a low 25.0%, which indicates that this behavioural model worked better than previously. 21,20 Less fear of pain may mean improved pain behaviour 44 and patient -doctor dialogues about ideas of pain can thus increase the patients' activity. 45 Depressive disorders are prevalent in primary care in Sweden; about 4%, and about a quarter of the people with musculoskeletal pain are depressed.…”

“…In a later study, pain behaviour was found to be, in the main, a learned phenomenon associated with sick leave, with a core of pain anxiety. 20 In that study, especially some of the immigrant women with little education showed much pain behaviour during the physiotherapy sessions (personal reports). Furthermore, many participants in all social groups often claimed that they were unable to do even a little household work and they dared to walk only slowly because they feared increasing pain and that this had affected their families in various ways.…”

“…Furthermore, many participants in all social groups often claimed that they were unable to do even a little household work and they dared to walk only slowly because they feared increasing pain and that this had affected their families in various ways. 20 Considering this and the fact that only a minor part of our immigrants with chronic pain had improved previously, we created an exercise programme (EP) with a pronounced behavioural part, principally aimed at reducing the patients' dysfunctional behaviours, a goal that would probably also benefit their families. The frame of this new EP was still the patient -doctor dialogues about the patients' concepts of their pain, aiming at reducing their anxiety and worries about pain.…”

“…19 The majority of this category of patients may rest because of pain on a sofa or in bed for many hours during day-time. 20 With these factors in mind and because of a heavy workload from this patient category at the primary health centre (PHC), a special rehabilitation programme was created in an immigrant district in Stockholm, Sweden. It was centred on the individual immigrant patient who was suffering pain or other benign disorders, and his or her special needs as regarded communication and personal support, and took into account the limited resources of the health personnel in primary care.…”