Background & Aims
There has been growing attention in recent decades to inequities in pain management and outcomes. There are strong calls for healthcare professionals and systems to attend to these issues in order to enhance health equity in pain management. Health inequities are systemic, avoidable, and unfair differences in health outcomes between groups of people [1]. Minoritised groups such as women, LGBTQI+ people, disabled people, refugees, racialised groups, migrants, and those with language differences have greater pain, worse outcomes and receive unequal pain treatment [2-4]. Yet what has been less explored is that when people are marginalised for two or more social categories inequities compound, due to the intersecting effects of multiple systems of power [5, 6]. The aim of this study was to explore how intersecting categories or systems of power surface in clinical encounters between clinicians and people with chronic pain and how they are (or are not) navigated in clinical interaction.
Methods
This qualitative study used 39 ethnographic observations from a larger project. The observations encompassed up to one hour of real-life clinical encounters between people with chronic low back pain and clinicians from a government funded multidisciplinary pain clinic in Australia. Data were collected between January 2020 and June 2021. We used the concept of intersectionality [7, 8] as a theoretical lens to provide an in-depth analysis of observations and provide critical insights into how identity categories operate not as mutually exclusive entities, but as reciprocally constructing phenomena that shape complex social inequities in pain management.. Using “intersectionality as a critical methodology” by Davis [9] we explored the intersection of pain experiences and systems of power about categories of “pain patient”, disability, race, gender, migration and socioeconomic status in clinical interactions.
Results
Our critical preliminary analysis suggested there are various intersecting characteristics impacting the care of pain patients including being a pain patient in itself. The constructed and chosen “pain patient” category was central to exploring intersecting systems of power. Being a pain patient was seen as stigmatising, and people had less power and control when compared to non-patients or healthcare providers. Other intersecting characteristics, such as being visibly disabled, non-white, and/or from a different linguistic background seemed to contribute to the pain patient receiving more discrimination and barriers in their pain management journey. Barriers operated in individual, interpersonal, and societal levels urging clinicians to better adapt their communication skills to avoid harmful assumptions about marginalised groups, adjust institutional and clinical regimes to cater for such groups, and consider how racism, ableism, sexism impact pain experiences more broadly.
Conclusions
Our preliminary findings show the complexity of the intertwined disadvantages experienced by people with pain about multiple and intersecting social categories, identities, and systems of power in their clinical encounters. An intersectionality lens can be valuable in bringing insights into the interconnection of various forms of differences and oppression intertwined at interpersonal and societal levels that people with pain experience. These insights allow interrogation and action towards the interpersonal and institutional factors responsible for the vulnerability that people with pain experience. Ultimately, clinicians and researchers can use intersectionality to advocate for reducing inequities in pain care.
References
1. McCartney, G., et al., Defining health and health inequalities. Public Health, 2019. 172: p. 22-30.
2.Mathur, V.A., et al., Mechanisms of injustice: what we (do not) know about racialized disparities in pain. PAIN, 2022. 163(6).
3.Craig, K.D., et al., Pain in persons who are marginalized by social conditions. PAIN, 2020. 161(2): p. 261-265.
4.Morales, M.E. and R.J. Yong, Racial and Ethnic Disparities in the Treatment of Chronic Pain. Pain Medicine, 2021. 22(1): p. 75-90.
5.Macgregor, C., et al., Intersectionality as a theoretical framework for researching health inequities in chronic pain. British Journal of Pain, 2023. 17(5): p. 479-490.
6.Bull, E., et al., Understanding ethnic minority service user experiences of being invited to and attending group pain programmes: A qualitative service evaluation. British Journal of Pain, 2022. 17(1): p. 58-70.
7.Crenshaw, K., Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color. Stanford Law Review, 1991. 43(6): p. 1241-1299.
8.Crenshaw, K.W., Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. 1989.
9.Davis, K., Intersectionality as Critical Methodology, in Writing Academic Texts Differently : Intersectional Feminist Methodologies and the Playful Art of Writing, N. Lykke, Editor. 2014, Taylor & Francis Group: London, UNITED KINGDOM. p. 17-29.
Presenting Author
Karime Mescouto
Poster Authors
Topics
- Racial/Ethnic/Economic Differences/Disparities