Background & Aims

Social inequities have significant relevance in chronic pain research. One way to understand inequity is through the concept of structural violence (SV), which refers to social structures (1,2) (i.e., classism, racism, sexism, etc.) that cause harm, inequity and marginalization. The experiences of many people living with chronic pain are informed by social structures that are tied to marginalization, (3-6) yet, little attention is paid to the mechanisms by which this happens. In a study of chronic pain and marginalization –COPE II Study (7)– we noticed how often people with chronic pain living in poverty described harmful experiences regarding their applications for disability benefits. We frame these difficulties as a form of SV. For this project, we conducted a sub-analysis of interviews, with a particular focus on understanding the harms stemming from disability benefits that people living with chronic pain experience in the context of profound social and health inequities.

Methods

This is a sub-analysis of an institutional ethnography (IE) of chronic pain and marginalization (COPE II). IE is a sociological approach that begins in people’s everyday experiences to explore institutional processes, (8) which is a useful approach to making visible the workings of structural violence. (9,10) Our team includes three family doctors, two anthropologists, and two sociologists. In the original study, we interviewed 23 people who identified as living with chronic pain and struggling to make ends meet. For this sub-analysis, we focused on the code “experience of being on social or disability assistance”. Meetings were held to review the coded data and affiliated transcripts, and to reflect on our understanding of what was being described. From here, we developed themes to present our interpretation of this data.

Results

Our preliminary results include the following five themes: 1) the struggles of navigating complex forms and processes; 2) managing relationships with and across settings (from physicians to case workers); 3) embedded and stigmatizing assumptions within the forms; 4) lived implications of delays in assistance; and 5) recommendations for the future.

Conclusions

Social inequities that inform health are often under-studied in research on chronic pain as they occupy different sectors. In this study we trace how texts, like those used to claim disability benefits, can cause significant harm among people who live with chronic pain. They are also often time-consuming and complicated for family physicians. Bringing forth the various ways in which harm and violence are embedded within and throughout the chronic pain experience will not only strengthen the claim for more socially grounded research (in both focus and discipline), but also call attention to how disability benefits can be modified in ways that work for people living with chronic pain and marginalization. Without this acknowledgement, these less visible yet powerful processes of violence and harm will continue.

References

1. Rylko-Bauer B, Farmer P. Structural violence, poverty, and social suffering. The Oxford handbook of the social science of poverty 2016:47-74.

2.Galtung J. Violence, peace, and peace research. Journal of peace research 1969;6(3):167-91.

3.Craig K, Holmes C, Hudspith M, Moor G, Moosa-Mitha M, Varcoe C, Wallace B. Pain in persons who are marginalized by social conditions. PAIN 2019;161(2):261-5.

4.Wallace B, Varcoe C, Holmes C, Moosa-Mitha M, Moor G, Hudspith M, Craig KD. Towards health equity for people experiencing chronic pain and social marginalization. International Journal for Equity in Health 2021;20(1):1-13.

5.Webster F, Connoy L, Sud A, Rice K, Katz J, Pinto AD, Upshur R, Dale C. Chronic struggle: An institutional ethnography of chronic pain and marginalization. The Journal of Pain 2023;24(3):437-48.

6.Dassieu L, Kaboré J-L, Choinière M, Arruda N, Roy É. Painful lives: Chronic pain experience among people who use illicit drugs in Montreal (Canada). Social Science & Medicine 2020;246:112734.

7.COPE II: Chronic Pain Ethnography. COPE: AN INSTITUTIONAL ETHNOGRAPHY OF THE SOCIAL ORGANIZATION OF CHRONIC PAIN CARE (https://copestudy.ca).

8.Smith D. Institutional Ethnography: A Sociology for People. Toronto: Alta Mira Press; 2005.

9.Odhiambo AJ, O’Campo P, Nelson LRE, Forman L, Grace D. Structural violence and the uncertainty of viral undetectability for African, Caribbean and Black people living with HIV in Canada: an institutional ethnography. International Journal for Equity in Health 2023;22(1):33.

10.Odhiambo AJ, Forman L, Nelson LE, O’Campo P, Grace D. Unmasking legislative constraints: an institutional ethnography of linkage and engagement in HIV healthcare for African, Caribbean, and black people in Ontario, Canada. PLOS Global Public Health 2022;2(9):e0000714.

Presenting Author

Fiona Webster

Poster Authors

Laura Connoy

PhD

Western University

Lead Author

E-mail

Ginetta Salvalaggio

MD

University of Alberta

Lead Author

E-mail

Kathleen Rice

PhD

McGill University

Lead Author

E-mail

Ross Upshur

MD,MSc,MA

University of Toronto

Lead Author

E-mail

Andrew Pinto

MD CCFP FRCPC MSc

University of Toronto

Lead Author

E-mail

Larissa Costa Duarte

PhD

University of Western Ontario

Lead Author

E-mail

Fiona Webster

Western University

Lead Author

E-mail

Topics

  • Racial/Ethnic/Economic Differences/Disparities