Socioeconomic Status and the Course and Consequences of Chronic Pain

Abstract

This article consists of a brief overview of the relationship between chronic pain (CP) and socioeconomic status (SES), a review of recent studies conducted in 2010 and then a discussion of the psychological meaning of the findings in light of wider understanding about SES and health [Bonathan C, Unpublished Data]. Chronic or persistent pain affects people across their lifespan, with significant impact on all aspects of life. It is associated with economic and social disadvantage [1], loss of work [2] and reduced work effectiveness [3].The risk factors for CP are similar to those for many chronic health conditions [4], but while sex and age are routinely considered, less attention is paid to unhealthy behaviors, such as smoking [5], and to other markers of SES. The biopsycho social model describes interacting factors in the onset, experience and outcome of CP. It pays particular attention to the role of emotional states, health beliefs and pain-related behaviors [6]. The social aspects are arguably the least explored [3], and this article focuses on an important aspect of the social environment; SES. There are two dimensions: economic (financial and material wealth) and social (such as education and community standing). Socioeconomic factors, such as lower levels of education, low income and unemployment are associated with higher rates of chronic and disabling pain [7]. However, the nature of the relationship between chronic pain and SES is unclear. Review methodsGiven that a thorough review was conducted in 1998 [8], we searched for papers examining the link between chronic pain and SES dated from 1998 to the present time. Databases such as PsycINFO, MEDLINE and Embase were used. Searches for references of relevant papers, combining terms, such as chronic and persistent pain, and all categories of SES were carried out. Of the 143 studies retrieved, 75 measured only partial aspects of SES and/or did not explore its relationship with chronic pain, 39 described treatment outcome, and 22 fell short of the inclusion criteria in other ways. This left seven studies, to which six were added from reference lists of reviews. Adjusting and rerunning the search with terms used in these studies (e.g., 'disabling pain') produced no new studies.

Classism and dehumanization in chronic pain: A qualitative study of nurses’ inferences about women of different socio‐economic status

“…One, that what happens at the interpersonal levelfor example, dehumanization in nurse-patient relationscannot be fully understood if disconnected from the cultural level, that is, the culturally shared belief systems and the burden that they impose on some patients, but not others (Hicken et al, 2018). It needs to be better investigated whether and how this burden is associated with the fact that individuals with lower SES are more likely to develop chronic pain and to have more disabling pain (Bonathan et al, 2013). This suggests that one form a 'stronger consideration of SES' (Schuz, 2017, p. 5) in health psychology should take is that of more analyses of the shared, cultural assumptions of health professionals regarding SES, and, two, that the psychosocial processes of dehumanization may mediate the effects of SES on pain assessment and treatment, helping account for social inequalities in pain care by negatively affecting L-SES people, and ultimately undermining the goal of equity in health.…”

“…Also, the use of shared belief systems is more likely when people deal with complicated tasks involving ambiguous evidence, as often happens in chronic pain (Burguess et al, 2017;Tait & Chibnall, 2014). In this regard, some studies suggest that classism interferes in pain assessment and treatment (Hollingshead et al, 2016;Maly & Vallerand, 2018), with chronic pain more prevalent among low-SES people (Bonathan et al, 2013;Breivik et al, 2013), who often have their pain under-assessed when compared to patients of middle/ high SES (Hollingshead et al, 2016;Meghani et al, 2012). However, the question of whether and how SES is associated with dehumanizing trait inferences in pain care has not yet been directly examined, mostly due to two trends.…”

Patients’ Perceptions of Chronic Pain During the Economic Crisis: Lessons Learned from Greece

“…Studies from Greece during the economic recession revealed a drop inself-rated health status, with an overall negative impact on health care, health, and well-being (13). The limited literature addressing the impacts of these issues on chronic pain indicates that lower socio-economic status and lower education combined with aggravating psychological factors contribute to the incidence of chronic pain and disability, but does not shed light on the effects of the economic crisis on patients' pain behavior (2,14). Therefore, in the context of a country that has been substantially affected by the recent financial crisis, this study aims to assess and comment on the possible impact of this crisis on the pain and quality of life of Greek patients suffering from chronic pain.…”

“I'm healthy, I don't have pain”- health screening participation and its association with chronic pain in a low socioeconomic status Singaporean population

“…Socioeconomic status (SES) and chronic pain are closely linked, with lower individual-SES associated with higher frequency of chronic pain [78]. Staying in a low-SES area is also independently associated with chronic pain [910]; perhaps because living in less socially cohesive neighborhoods interacts with psychological factors known to increase chronic pain [11]. However, low SES is also associated with disparities in access to health services.…”