Chronic pain and psychological distress among long-term social assistance recipients – An intolerable burden on those on the lowest steps of the socioeconomic ladder
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Harald Breivik
In this issue of the Scandinavian Journal of Pain Borghild Løyland publishes a study focusing on chronic pain among long-term social assistance recipients in Norway. She documents how chronic pain and psychological distress often co-occur. When chronic pain and psychological distress do co-occur, they tend to magnify the loss of quality of life that long-term social assistance recipients experience [1].
1 Chronic pain is one major reason for early disability retirement in Norway
Chronic pain, pain that is there week after week, month after month, year after year, pain that interferes with activities of daily living, pain that reduces ability to have a work to go to, pain that causes regular income to disappear, this type of pain causes patients to have catastrophizing thoughts about never getting back to normal life. They plunge into mental fatigue, depression and suicidal ideas. In Norway, the most common cause of early disability pension is health problems where chronic pain is one major part of the health problem [2].
2 Long-term social assistance recipients – i.e. those receiving social assistance more than 6 of the last 12 months – who also have chronic pain and psychological distress – have miserable quality of life
Borghild Løyland’s data indicate that problems during childhood and the early years of life are associated with psychological distress later in life. Being a victim of long-term bullying during the years in school is associated with increased risk of having psychological distress later in life. Being born into a family with economic difficulties may increase risk of having socioeconomic problems later in life [1].
3 Patients with pronounced socioeconomic problems often do not benefit from treatment at pain clinics
Patients with chronic pain conditions referred to multidisciplinary pain clinics often have socioeconomic problems. Although their socioeconomic problems are results of their chronic pain condition, such socioeconomic problems also are severe obstacles to any meaningful treatment of their chronic pain condition [3].
4 An experienced social worker is a valuable member of the multidisciplinary team of a pain clinic
This is well described in three important papers from Finland [4,5,6]. A social worker with knowledge and extensive experience in how to help chronic pain patients with the many and varied socioeconomic problems they have, is a prerequisite for other interventions to succeed.
5 Pain cannot be eradicated by removing social inequalities, but inequalities in management should be eradicated
Social determinants of health inequalities are “facts of life” [7,8]. The huge inequalities in health caused by poverty and other results of social differences cannot be cured by medical means, they can, however, be reduced by sound politics that reduce differences between “haves” and “have-nots” within and between countries [8]. Persons living in the 5 Nordic countries benefit hugely from social and economic policies that created societies with the least social differences of all countries in the world [7,8]. This has not removed chronic pain as a health problem [9]. However, focusing on social inequalities associated with chronic pain, as Borghild Løyland does [1], is a first, necessary step in improving this health problem.
DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2015.12.003.
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Conflict of interest: None declared.
References
[1] Løyland B. The co-occurrence of chronic pain and psychological distress and its associations with salient socio-demographic characteristics among long-term social assistance recipients in Norway. Scand J Pain 2016;11: 65–72.Search in Google Scholar
[2] Nielsen CS. Chronic pain is strongly associated with work disability. Scand J Pain 2013;4:180–1, http://dx.doi.org/10.1016Zj.sjpain.2013.08.002.Search in Google Scholar
[3] Heiskanen T, Roine RP, Kalso E. Multidisciplinary pain treatment – Which patients do benefit? Scand J Pain 2012;3:201–7, http://dx.doi.org/10.1016/j.sjpain.2012.05.073.Search in Google Scholar
[4] Aho H, Kauppila T, Haanpaa M. Patients referred from a multidisciplinary pain clinic to the social worker, their socio-demographic profile and the contribution of the social worker to the management of the patients. Scand J Pain 2010;1:213–9, http://dx.doi.org/10.1016/j.sjpain.2010.09.008.Search in Google Scholar
[5] Hagelberg NM. Social work in a pain clinic. Scand J Pain 2010;1:211–2, http://dx.doi.org/10.1016/j.sjpain.2010.09.005.Search in Google Scholar
[6] Aho H, Kauppila T, Haanpaa M. Patients referred from a multidisciplinary pain clinic to the social worker, their general health, pain condition, treatment and outcome. Scand J Pain 2010;1:220–6, http://dx.doi.org/10.1016/j.sjpain.2010.09.009.Search in Google Scholar
[7] Marmot M. Social determinants of health inequalities. Lancet 2005;365:1099–104.Search in Google Scholar
[8] Judt T. Ill fares the land. London: Penguin Books Ltd.; 2010, ISBN 978-0-14-196269-6.Search in Google Scholar
[9] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006;10:287–333.Search in Google Scholar
© 2016 Scandinavian Association for the Study of Pain
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- Editorial comment
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- Original experimental
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- Editorial comment
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- Observational study
- Pain-related factors associated with lost work days in nurses with low back pain: A cross-sectional study
- Editorial comment
- Assessment of persistent pelvic pain after hysterectomy: Neuropathic or nociceptive?
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- Editorial comment
- Transmucosal fentanyl for severe cancer pain: Nasal mucosa superior to oral mucosa?
- Original experimental
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- Clinical pain research
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- Editorial comment
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- Announcement
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