"Merey pureh jism may Dard hai!" she shouted across
the room at me.
Translated that means, "My whole body hurts!" This is not
an uncommon presentation in my Pain Management clinic. Total body
pain, somatisation or Fibromyalgia crosses cultures, nations and
traditions. However, this wasn't a person presenting to me in clinic.
It was an elderly relative.
Chronic widespread pain is incredibly common in the population. As
the population of the world lives longer, this is going to become one
of the biggest public health issues around. The socioeconomic burden
of Pain and Musculoskeletal problems is well documented and is likely
to rise into billions worldwide.
COVID has changed a lot of things in general practice. Changes which
would have taken years to instigate while GPs swam against the tide of
CQC regs, CCG bureaucracy, Royal College and NICE diktats...happened
overnight. We adapted and we responded quickly and effectively. It
has been a 'game-changer' for some a, 'leveller' for others. For me it
has been eye-opening. I have reflected on many
things over the last 11 months. From the behaviour of those who use
general practice to the indecisiveness of some of our leaders.
Colleagues, relatives and friends have died. This invisible killer has
brought to the fore the disparities in the healthcare we provide as
well as how the beloved NHS treats its staff.
Managing Pain effectively is my passion. It is becoming more and
more difficult to manage persistent pain in the general population.
Guidelines are limiting options for clinicians and patients year on
year. Effective evidence based resources are scarce. Add into the mix
health inequity and we have a perfect storm. My parents generation
left their home and families to start a new life in the UK. They were
incentivised and invited by the government of the day. The completed
menial, hard manual labour jobs. Jobs which the indigenous population
felt were below them. They worked 6 days per week, every week. Sick
leave was unheard of. Holidays weren't taken and any spare money was
sent back home. Living conditions were difficult and the local
neighbourhood was not always welcoming. My parents generation worked
hard so I could have the opportunities that they only dreamed of.
Now it is my turn to help provide them with what most of us could
consider as a basic human right... the right to not be in
pain. My mother is struggling with arthritic knees and
associated leg pains. The Pakistani community has lived in fear these
last 11 months, like many communities. The statistics are scary. If
you are of South-Asian background you are at a significantly increased
risk of complications and death from COVID. Research into the why and
how is ongoing. One thing which is clear to me is that structural
racism plays a role.
Is the NHS institutionally racist? A question which has caused inner
turmoil and torment. It feels like the 'system' is failing my BAME
patients. There is a lack of training on how non-white communities
conceptualise and express persistent pain. Chronic Pain research (UK)
in non-white populations is scarce, if present at all. Pharmacological
preparations have a weak evidence base in white populations and so one
could extrapolate that they are likely to be ineffective in non-white
populations. Drug development and research is based on and aimed
towards white middle class populations. Unbelievably, some 50 years
since my parents arrived, culturally specific and sensitive Pain
Management Programmes are astonishingly few and far between. BAME
focused Trauma responsive care and counselling is unheard of. How did
we get to this sorry state of affairs. Things need to change and