ETHNICITY AND PAIN: AN EXPLORATION OF THE EXPRESSION OF PAIN AMONG FOUR ETHNIC MINORITY GROUPS IN CANADA
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Introduction: Approximately one in five Canadian adults suffers from chronic pain, a condition which has been associated with reduced quality of life, reduced psychological adjustment, increased disability, potential for reduced income, and high levels of healthcare utilization. A recent review of the literature has shown that the profile of pain reporting appears to be different in ethnic minority (EM) populations. As Canada increasingly becomes a multiethnic society with an influx of immigrants from non-European and non-English speaking countries, it is important for the healthcare system to consider socio-cultural factors related to diagnosis and treatment in order to optimize health outcomes. While much has been done in health and social services to accommodate the diverse needs of the Canadian population as a whole, very little research has sought specifically to investigate pain among different EM populations. Presently, it appears that no research exists investigating the experience of pain in different EM populations. This research gap may contribute to differences in pain assessment, treatment, and outcomes, contributing to perceived differences in quality of healthcare and in health status. Objectives: The three objectives for this study were: 1) to report the differences in chronic pain expression between White Canadians and EM Canadians who self-reported as South Asian, Middle Eastern, East Asian, or Black Canadians; 2) to investigate whether there were differences in the prevalence of chronic pain (the primary dependent variable), pain intensity, and activity limitation (the secondary dependent variables) among Middle Eastern, South Asian, Black, and East Asian EM groups in Canada; 3) to explore the association between the bio-psychosocial risk factors (including acculturation) and chronic pain among the members of the four EM groups who reported chronic pain. Methods: An exploratory secondary data analytical study was conducted using cross-sectional data from Canadian Community Heath Survey (years 2007-2013). The study sample included Canadians who self-reported as Black, or with origins in South Asia, the Middle East, Africa and East Asia. Three variables related to being free of pain and discomfort were analysed. Chronic pain prevalence, pain intensity and pain interference with daily activity were described for Canadian EM and majority (non-Hispanic white) populations. Logistic regression models were used to analyse the factors associated with pain expression, intensity and interference with normal activity. To explore the association between psychological and social factors associated with chronic pain expression, the research used a bio-psychosocial framework of pain expression adapted from the Determinants of Health: The 21st Century Field Framework and the Bio-psychosocial Framework presented by Gatchel et al. 2010. These frameworks have been used in previous pain literature. Results: Chronic pain was found to be reported significantly more often by White Canadians (19.3%, 95%CI: 16.9%-21.6%) compared to the combined four EM groups (13.1%, 95%CI: 10.8%-15.4%). Severe pain intensity was also reported statistically significantly more often by White Canadians (17.3%, 95%CI: 16.3%-18.1%) compared to all EM groups (13.0%, 95%CI: 10.6%-15.3%). Logistic regression revealed inter-ethnic differences in pain intensity reporting where the odds of the East Asian group experiencing ‘high’ pain intensity was 0.47 (95%CI: 0.31-0.69) times the odds of the Black Canadians group. Even after adjusting for the combination of psychological and socio-demographic factors from the framework, this group still had significantly reduced odds of reporting ‘severe’ pain intensity (OR: 0.38, 95% CI:0.22,0.64) compared to Black Canadians. Multivariable analysis found self-reported mental health, depression, anxiety, alcohol frequency, sex, age and marital status to be associated with pain expression among these four EM groups. Conclusion: Understanding and accurately measuring pain in EM groups requires high levels of ‘cultural competence’ in healthcare professionals. When assessing chronic pain, specific attention should be given when working with highly acculturated EM groups who have immigrated and lived in Canada for more than 10 years.