Korean J Pain.  2017 Jan;30(1):34-43. 10.3344/kjp.2017.30.1.34.

“I'm healthy, I don't have pain”- health screening participation and its association with chronic pain in a low socioeconomic status Singaporean population

Affiliations
  • 1Singhealth Internal Medicine, Singapore General Hospital, Singapore. weeliangen@gmail.com
  • 2Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
  • 3National Psychiatry Residency Program, National Healthcare Group, Singapore.
  • 4Department of Anaesthesia, Ng Teng Fong General Hospital, JurongHealth, Singapore.
  • 5Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.

Abstract

BACKGROUND
We sought to determine the association between chronic pain and participating in routine health screening in a low socioeconomic-status (SES) rental-flat community in Singapore. In Singapore, ≥ 85% own homes; public rental flats are reserved for those with low-income.
METHODS
Chronic pain was defined as pain ≥ 3 months. From 2009−2014, residents aged 40−60 years in five public rental-flat enclaves were surveyed for chronic pain; participation in health screening was also measured. We compared them to residents staying in adjacent owner-occupied public housing. We also conducted a qualitative study to better understand the relationship between chronic pain and health screening participation amongst residents in these low-SES enclaves.
RESULTS
In the rental-flat population, chronic pain was associated with higher participation in screening for diabetes (aOR = 2.11, CI = 1.36−3.27, P < 0.001), dyslipidemia (aOR = 2.06, CI = 1.25−3.39, P = 0.005), colorectal cancer (aOR = 2.28, CI = 1.18−4.40, P = 0.014), cervical cancer (aOR = 2.65, CI = 1.34−5.23, P = 0.005) and breast cancer (aOR = 3.52, CI = 1.94−6.41, P < 0.001); this association was not present in the owner-occupied population. Three main themes emerged from our qualitative analysis of the link between chronic pain and screening participation: pain as an association of "major illness"; screening as a search for answers to pain; and labelling pain as an end in itself.
CONCLUSIONS
Chronic pain was associated with higher cardiovascular and cancer screening participation in the low-SES population. In low-SES populations with limited access to pain management services, chronic pain issues may surface during routine health screening.

Keyword

Asian; Chronic pain; Health screening; Low-income; Mixed methods; Qualitative

MeSH Terms

Asian Continental Ancestry Group
Breast Neoplasms
Chronic Pain*
Colorectal Neoplasms
Dyslipidemias
Early Detection of Cancer
Humans
Mass Screening*
Pain Management
Public Housing
Singapore
Social Class*
Uterine Cervical Neoplasms

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Adriana Banozic, Ana Miljkovic, Marijana Bras, Livia Puljak, Ivana Kolcic, Caroline Hayward, Ozren Polasek
Korean J Pain. 2018;31(1):16-26.    doi: 10.3344/kjp.2018.31.1.16.


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