Background & Aims

While chronic pain conditions affect approximately 20% of the global adult population, it has been found to be significantly more prevalent, severe, and disabling for females and older adults [1,2]. Although the prevalence of chronic pain is known to be higher in populations affected by social inequities, racism, poverty, and other experiences of marginalization, access to pain care is not equitably distributed [3]. As such, there is a desperate need for innovation in the delivery of pain services that reflects the needs and requirements of the pain population. The aim of this study is to identify which patients are accessing interprofessional tertiary care and to elucidate the intersection between sex, age, marginalization, and the reason for the referral.

Methods

A retrospective chart review of all accepted referrals at a large interprofessional tertiary care partnership from January 1st, 2023, until December 31st, 2023, was conducted. Sex, age, address (postal code), and reason for the referral were extracted from the referral documentation. The marginalization index for each patient was calculated with the use of the Ontario Marginalization Index (ON-Marg). Residential instability, material deprivation, dependency, and ethnic concentration of the patient’s postal code are used in the ON-Marg to generate a standardized marginalization score. Preliminary analysis includes Chi-squared tests with a significance of p < 0.05 were conducted to determine differences. This initiative was formally reviewed by institutional authorities at Women’s College Hospital and was deemed not to require Research Ethics Board approval (APQIP # 2022-0066-P).

Results

A total of 5071 patients were accepted for interprofessional care in 2023, with females accounting for 67.2% of referrals. Approximately 40% of all referrals were between the ages of 45-64 years with similar proportion of females and males across all age categories. The top three reasons for referral for females include musculoskeletal pain (28.9%), radicular pain (11.6%), and widespread pain syndromes (12.7%) and, for males include musculoskeletal pain (30.1%), radicular pain (13.4%), and neuropathic pain (12.9%). Females were significantly more likely than males to be referred for headaches, abdominal pain, pelvic pain, and widespread pain (p < 0.05). However, females were less likely to be referred for opioid related issues and neuropathic pain when compared to males (p < 0.05). There were no statistical differences in the marginalization indices between the sexes. However, in adults over 80 years, 26.6% of females were marginalized, compared to only 16.7% of males.

Conclusions

Our results support prior literature showing the disproportionate impact of chronic pain on females [1]. While sex and gender have been shown to contribute to the pain onset and outcomes in prior research, our findings highlight the diagnostic differences between females and males living with pain. The higher degree of marginalization in females above 80 years suggests that older females may be a particularly vulnerable population that requires specific care. These results highlight the necessity for comprehensive pain care to be tailored to the needs of females as well as additional considerations towards care delivery models that are accessible for this patient population.

References

1. Osborne NR, Davis KD. Sex and gender differences in pain. In: International Review of Neurobiology. Academic Press Inc.; 2022. p. 277–307.

2. Domenichiello AF, Ramsden CE. The silent epidemic of chronic pain in older adults. Prog Neuropsychopharmacol Biol Psychiatry. 2019;93:284–90.

3. Craig KD, Holmes C, Hudspith M, Moor G, Moosa-Mitha M, Varcoe C, et al. Pain in persons who are marginalized by social conditions. Vol. 161, Pain. NLM (Medline); 2020. p. 261–5.

Presenting Author

Tania Di Renna

Poster Authors

Tania Di Renna

MD

TAPMI

Lead Author

Anuj Bhatia

MD

Toronto Western Hospital

Lead Author

Hance Clarke

MD

University Health Network, University of Toronto

Lead Author

David Flamer

MD

Sinai Health

Lead Author

John Flannery

MD

Toronto Rehabilitation Institute-University Health Network

Lead Author

Andrea Furlan

IWH

Lead Author

Dinesh Kumbhare

MD

University of Toronto

Lead Author

James Khan

MD

Sinai Health

Lead Author

Karim Ladha

MD

Unity Health

Lead Author

Howard Meng

MD

Sunnybrook health Sciences Centre

Lead Author

Adriano Nella

MSc

Women's College Hospital

Lead Author

Brittany Rosenbloom

PhD

Women's College Hospital

Lead Author

Andrew Smith

MD

Centre for Addiction and Mental Health (CAMH)

Lead Author

Cara Stanley

Women's College Hospital

Lead Author

David Sussman

Unity Health

Lead Author

Rachael Bosma

PhD

Women's College Hospital

Lead Author

Topics

  • Gender/Sex Differences