Pain, BAME and Inequity

Are we failing non-white people who have persistent pain? 

"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 change quickly. 


 

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