Pain matters- which is why we need to deepen our understanding of Pain in BAME

Trauma is often an underlying factor in chronic pain and illness, yet there is frequently a lack of awareness about trauma and PTSD within primary care settings. As a result, these deep-seated traumas can manifest as chronic pain and a range of other chronic illness symptoms. In many cases, patients are treated for pain and mental health issues through a series of standardized procedures that do not fully address the root causes. Consequently, these patients often cycle through the healthcare system without experiencing significant improvements in their health or conditions.

Chronic pain, mental health issues, trauma, and social challenges are deeply interconnected, often coexisting and compounding each other. Despite this, treatment and management are typically fragmented across different agencies, leading to incomplete and ineffective care. This disjointed approach places a significant burden not only on individuals but also on the NHS, social services, and mental health agencies. Although the system includes various provisions for care, the demand continues to grow, exacerbating the strain on resources.

The NHS has policies in place that advocate for personalized and integrated care. However, a lack of understanding of these complex challenges, alongside stringent evidence-based standards and insufficient funding for research in these specific areas, perpetuates a vicious cycle.

Lessons Learned from Community of Practice: A Case Study

Chronic pain is a substantial issue in the UK, affecting nearly half of the population. In October 2019, Aarogyam (UK) CIC, Hindu Sahitya Kendra, and a dedicated team of volunteers launched a walk-in pain support group in Belgrave. The initiative, running every Saturday from 9 a.m. to 4 p.m., was designed to assess community needs and identify gaps in chronic pain management programs, with the intention of collaborating with the NHS and academic institutions to address these gaps. However, the findings revealed unexpected and concerning trends.

Over a three-month period, 127 patients of BAME background with diagnosed chronic pain conditions—including fibromyalgia, musculoskeletal pain, arthritis, neuropathic pain, chronic pain syndrome, back pain, and headache disorders—participated in the program. Notably, 28% of these patients reported experiencing domestic abuse over periods ranging from 6 to 32 years, with an average duration of 18.92 years. Shockingly, only two individuals had reported their abuse to the police, but due to lack of evidence, the perpetrators faced no consequences. The majority had not reported their situation to GPs or other support services, continuing to live with their abusers.

Furthermore, approximately 54% of the participants had a history of long-term trauma, such as childhood abuse, previous accidents, or post-natal depression. Despite undergoing psychotherapy sessions, neither the patients nor the consultants recognized the potential long-term impact of these traumas on their chronic pain. Previous research indicates that up to 50% of chronic pain cases are associated with PTSD, yet this critical connection often goes unnoticed during assessments and rehabilitation efforts. The remaining 18% of participants developed chronic pain following accidents, falls, or surgeries.

Despite completing all NHS referrals and services, over 86% of participants reported that their pain persisted and had worsened over time, leading to co-morbid mental health issues. Many expressed frustration, feeling that they were merely ticking boxes and not being genuinely heard or understood. A significant number believed that being referred to a counselor implied that their pain was "in their head."

In response, the program enrolled each participant in physiotherapy or personalized pain management, including medical yoga. Additionally, culturally competent counseling was provided to address long-standing concerns. This comprehensive approach achieved an 86% success rate, with patients beginning to manage their pain effectively within an average of 5.5 weeks (under review). This case study highlights the need for a more holistic, trauma-informed approach in treating chronic pain and associated conditions. It underscores the importance of understanding the complex interplay between trauma and chronic pain and the necessity of integrated, culturally sensitive care.

In summary, the path forward requires a concerted effort to break down silos within the healthcare system and adopt a more integrated, patient-centered approach. By prioritizing trauma-informed care, enhancing provider training, and fostering collaborative community support, we can improve the quality of care for individuals suffering from chronic pain and associated conditions, ultimately leading to better health outcomes and quality of life.