Background & Aims
There is a concerning trend of elevated chronic pain among sexual and gender minority (SGM) individuals. Emerging evidence supports the existence of a pain disparity in this population, prompting a more comprehensive exploration of existing literature to illuminate the landscape of chronic pain experienced by SGM people. This integrative scoping review seeks to describe the diverse types of pain and identify the prevalence of chronic pain within specific SGM subgroups. Despite an emerging concern, the underlying causes of this pain disparity remain elusive, making this review a crucial step towards understanding and addressing the complexities surrounding chronic pain within the SGM community. This examination of the literature aimed to provide a nuanced understanding of the prevalence and diverse experiences of chronic pain within the SGM community. This is the first integrative scoping review that has ever been conducted on this timely question.
Methods
This research employed a mixed studies systematic review approach, using the Mixed Methods Appraisal Tool (MMAT), to rigorously analyze both qualitative and quantitative literature on the experiences of SGM individuals with chronic pain. The central research question guiding this study was: What are the rates of chronic pain and how are these conditions experienced by SGM individuals? A comprehensive search was conducted, spanning several databases and sources, including Embase, Scopus, MEDLINE, citation searching, CINAHL, CENTRAL, Cochrane Reviews, as well as hand searching. Inclusion criteria were studies examining chronic pain which must have had a discussion of its impact in SGM individuals. Articles must have included original research. Narrative reviews, protocols, and case reports were excluded.
Results
From an initial pool of 6,188 studies, 54 were selected for inclusion in the final analysis. Sample sizes ranged from 8 subjects to analyses on more than 50 million subjects receiving Medicare. Participants included lesbian, gay, bisexual and transgender men and women worldwide. Ages of study participants ranged from 14-85 years. Studies were conducted all over the world. Pain conditions included HIV-related pain, anorectal and vaginal pain, non-cardiac chest pain related to chest binding in transgender men, chronic musculoskeletal pain, migraines, and others. Qualitative findings revealed themes including loss in participation, independence, and support systems. Social challenges were inherent, with themes like loneliness, emotional disturbances, past trauma, and victimization increasing the risk of substance use and diminishing quality of life. Quantitatively, rates of chronic pain in the SGM population ranged from 9-100%, depending on the pain condition and sample size in question.
Conclusions
This review sheds crucial light on unique challenges faced by sexual and gender minority (SGM) individuals with chronic pain, emphasizing the impact on quality of life. Losses in participation, independence, and support underscore adversity. The link between chronic pain and psychological issues, with an increased risk of substance use, reveals the multifaceted nature of chronic pain for SGM people. These findings advocate for targeted interventions addressing social determinants and psychosocial dimensions of pain. This study provides a necessary foundation for research on the diverse pain experiences of those in the SGM community.
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