Background & Aims
The UK has both high rates of chronic pain and an ethnically diverse population. However, chronic pain prevalence, and its impact, may differ across ethnic groups, socially disadvantaged, and people from lower socio-economic backgrounds (1-4)
UK government data report that chronic pain prevalence is the same among all ethnic groups (34%) other than black ethnic groups (44%) (5). However, other estimates of prevalence in minority ethnic populations vary widely (34 – 72%) (1,3) indicating a large degree of heterogeneity in findings.
The aim of this critical appraisal is to systematically identify and assess the quality of published evidence related to the prevalence of chronic pain within ethnic minority groups in the UK. This project forms part of a wider ongoing study to determine an accurate estimate of the prevalence and impact of chronic pain in ethnic minority groups within the UK adult population
Methods
A structured search was conducted for population-based observational studies (English) published between 2000-2023. Databases searched include CINAHL, Scopus, EMBASE, MEDLINE, Cochrane Library and Campbell Collaboration. Search terms included: United Kingdom AND prevalence AND (chronic pain* OR long-term pain) AND ethnic minority*.
Records were screened by two reviewers. Eligible papers were those that reported data on A) adults 18 years and above and B) minority ethnic populations in the UK. The Joanna Briggs Institute Critical Appraisal tool (6) was used to appraise the quality of the published studies. This checklist comprises nine items, each with a choice of three responses (yes, no, and unclear risk of bias) related to appropriate sample frame, sampling, study subjects, settings, sample size, classification, outcome measurement, statistical analysis and response rate.
Results
The search resulted in 98 records after removing duplicates. Following title and abstract screening, 35 progressed to full text review. Reasons for exclusion were based on study population, study settings and design, absence of chronic pain prevalence data in minority ethnic groups.
Six studies were included in this critical review. Of these, one (7) had low risk of bias (yes on all items) three (3,8,9) had moderate risk of bias (unclear for at least one item), and two (1,10) had a high risk of bias (no for at least one item).
These observational studies published from 2003 to 2023 (1,3,7-10) included findings from Primary (1,7) or Secondary Care (9) or Great Britain-wide populations (3,8,10) ranging in sample size from 245 (9) to over 500,000 (10). Five studies reported between two to eight different ethnic groups (1,3,7,8,10) whilst one (9) reported solely on people of Pakistani ethnicity. Musculoskeletal, neuropathic or widespread pain conditions were studied.
Conclusions
Results revealed only six studies (1,3,7-10) in this field and a lack of dedicated studies investigating chronic pain among minority ethnic populations in the UK. These studies had, on average, a moderate risk of bias, indicating the limitations of the published evidence on chronic pain prevalence estimates. Our results identify the need to conduct rigorous research that more accurately estimates the prevalence of chronic pain in ethnic minority groups in the UK.
References
1. Choudhury, Y., Bremner, S.A., Ali, A., Eldridge, S., Griffiths, C.J., Hussain, I., Parsons, S., Rahman, A. and Underwood, M. (2013) Prevalence and impact of chronic widespread pain in the Bangladeshi and White populations of Tower Hamlets, East London. Clinical Rheumatology 32 (9), pp. 1375–1382. doi:10.1007/s10067-013-2286-3.
2. Donaldson LJ. 150 years of the Annual Report of the Chief Medical Officer: on the state of the public health. Department of Health, 2008.
3. Nicholl BI, Smith DJ, Cullen B, Mackay D, Evans J, Anderson J, et al. Ethnic differences in the association between depression and chronic pain: cross sectional results from UK Biobank. BMC Family Practice. 2015;16:128. doi: 10.1186/s12875-015-0343-5.
4. Versus Arthritis. Chronic pain in England: Unseen, Unequal, Unfair. 2021. www.versusarthritis.org
5. Public Health England (PHE). Chronic pain in adults 2017: Health Survey for England. 2017. https://assets.publishing.service.gov.uk/government
6. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020. doi.org/10.46658/JBIMES-20-12
7. Webb, R., Brammah, T., Lunt, M., Urwin, M., Allison, T. and Symmons, D. (2003) Prevalence and predictors of intense, chronic, and disabling neck and back pain in the UK general population. Spine 28 (11), pp. 1195–1202.
8. Baskozos, G., Hébert, H.L., Pascal, M.M.V., Themistocleous, A.C., Macfarlane, G.J., Wynick, D., Bennett, D.L.H. and Smith, B.H. (2023) Epidemiology of neuropathic pain: An analysis of prevalence and associated factors in UK Biobank. Pain Reports
9. Helliwell, P.S., Ibrahim, G.H., Karim, Z., Sokoll, K. and Johnson, H. (2006) Unexplained musculoskeletal pain in people of South Asian ethnic group referred to a rheumatology clinic – relationship to biochemical osteomalacia, persistence over time and response to treatment with calcium and vitamin D. Clinical and experimental rheumatology. 24 (4), pp. 424–7.
10. Macfarlane, G.J., Beasley, M., Smith, B.H., Jones, G.T. and Macfarlane, T.V. (2015) Can large surveys conducted on highly selected populations provide valid information on the epidemiology of common health conditions? An analysis of UK Biobank data on musculoskeletal pain. British Journal of Pain [online]. 9 (4), pp. 203–212.
Presenting Author
Seba Ghosh
Poster Authors
Jenny Lewis
PhD
Royal United Hospitals Bath NHS Foundation Trust
Lead Author
Seba Ghosh
University of the West of England
Lead Author
Jeremy Gauntlett-Gilbert
PhD
Bath National Pain Centre, Royal United Hospital NHS Trust, Bath, UK
Lead Author
Gareth T Jones
PhD
Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberde
Lead Author
Mwidimi Ndosi
PhD
School of Health and Social Wellbeing, University of the West of England, Bristol UK
Lead Author
Topics
- Epidemiology