Unseen Influences:

The Sociology of Chronic Pain

Outcomes

Learners completing this activity report improvements in:

Discussing self-medication tactics and socioeconomic variables with patients
Updating patient intake forms
Evaluating patients based upon their entire life experience

Overview

Pain and pain treatment reflect, and have wide-ranging implications for, public policy. Whether we analyze pain quantitatively or qualitatively, focusing on its distribution in the population, its social causes and consequences, or its subjective meanings for individuals, pain reflects the social conditions, sociopolitical context, and health0-related beliefs of a society.

Within the biopsychosocial model of pain, "social forces" or "social determinants" are largely researched and understood as social-psychological factors. Thus neglecting the role of structural inequalities that shape who experiences pain, how they experience it, and how others view their pain. Additionally, upstream, fundamental driving factors such as public policy, medical, pharmaceutical and insurance industries, and the socio-political context underlies all of these factors and their interrelationships. To ignore these upstream determinants is to have an incomplete understanding of pain.

Medical sociology can and must rebalance the lopsided biomedically-focused pain models with a greater understanding of the social context and its profound effect on pain.

Learning Objectives

As a result of participating in this activity, learners will be able/better able to:

Apply a better understanding of the impacts of chronic pain on all-cause mortality when developing treatment plans and communicating with patients
Begin or increase the frequency of discussing with my patients whether they may be using alcohol to self-medicate or as a distractor of pain
Utilize the responses to diagnostic questions inquiring about financial hardships for patients with chronic pain

Desirable Physician Attributes

Systems-based Practice [ACGME/ABMS] Awareness and responsiveness to larger context and system of health care, use of system resources
Patient Care [ACGME/ABMS & IOM] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
Provide Patient-centered Care [IOM] Identify, respect, and care about patients’ differences, values, preferences and expressed needs; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health
Interpersonal and Communication Skills [ACGME/ABMS] The effective information exchange and teaming with patients, their families, and other health professionals
Professionalism [ACGME/ABMS] Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations.
Medical Knowledge [ACGME/ABMS] about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

This course addresses requirements for physicians and surgeons to participate in continuing education that includes specified instruction in the understanding of implicit bias in medical treatment.

Cultural competency. For the purposes of this section, “cultural competency” means a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups, and communities. At a minimum, cultural competency is recommended to include the following:
1. Applying linguistic skills to communicate effectively with the target population.
2. Utilizing cultural information to establish therapeutic relationships.
3. Eliciting and incorporating pertinent cultural data in diagnosis and treatment.
4. Understanding and applying cultural and ethnic data to the process of clinical care, including, as appropriate, information pertinent to the appropriate treatment of, and provision of care to, the lesbian, gay, bisexual, transgender, and intersex communities.

Accreditation & Designation

Release date: This activity was released 8/27/2021.

Termination date: The content of this activity remains eligible for CME Credit until 8/26/2024, unless reviewed or amended prior to this date.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this other activity (blended learning) for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships

Neither the presenter, reviewers nor any other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, any financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Additional Reading

Grol-Prokopczyk, H. (2017). Sociodemographic disparities in chronic pain, based on 12-year longitudinal data. Pain, 158(2), 313.
Poleshuck, E. L., & Green, C. R. (2008). Socioeconomic disadvantage and pain. Pain, 136(3), 235.
Brandão, T., Campos, L., De Ruddere, L., Goubert, L., & Bernardes, S. F. (2019). Classism in pain care: The role of patient socioeconomic status on nurses’ pain assessment and management practices. Pain Medicine, 20(11), 2094-2105.
Yu, T., Wei, Z., Xu, T., Gamber, M., Han, J., Jiang, Y., ... & Sun, W. (2020). The association between the socioeconomic status and body pain: A nationwide survey. Medicine, 99(12).
Pizzo, P. (2011). Relieving pain in America: a blueprint for transforming prevention, care, education, and research.
Bilkey, W. J. (1996). Confusion, fear, and chauvinism: Perspectives on the medical sociology of chronic pain. Perspectives in biology and medicine, 39(2), 270-280.
Fillingim, R. B., Loeser, J. D., Baron, R., & Edwards, R. R. (2016). Assessment of chronic pain: domains, methods, and mechanisms. The Journal of Pain, 17(9), T10-T20.
Montez, J. K., Beckfield, J., Cooney, J. K., Grumbach, J. M., Hayward, M. D., Koytak, H. Z., ... & Zajacova, A. (2020). US state policies, politics, and life expectancy. The Milbank Quarterly, 98(3), 668-699.
Zajacova, A., Grol-Prokopczyk, H., & Zimmer, Z. (2021). Sociology of Chronic Pain. J. Health and Social Behavior
Bendelow, G. A., & Williams, S. J. (1995). Transcending the dualisms: towards a sociology of pain. Sociology of health & illness, 17(2), 139-165.
Wang, H. L., Kroenke, K., Wu, J., Tu, W., Theobald, D., & Rawl, S. M. (2012). Predictors of cancer-related pain improvement over time. Psychosomatic Medicine, 74(6), 642.
Fuentes, M., Hart-Johnson, T., & Green, C. R. (2007). The association among neighborhood socioeconomic status, race and chronic pain in black and white older adults. Journal of the National Medical Association, 99(10), 1160.
Cutler, D. M., Meara, E., & Stewart, S. (2020). Socioeconomic status and the experience of pain: an example from knees (No. w27974). National Bureau of Economic Research.
Reitsma, M. L., Tranmer, J. E., Buchanan, D. M., & Vandenkerkhof, E. G. (2011). The prevalence of chronic pain and pain-related interference in the Canadian population from 1994 to 2008. Chronic Dis Inj Can, 31(4), 157-164.
Hoffman, P. K., Meier, B. P., & Council, J. R. (2002). A comparison of chronic pain between an urban and rural population. Journal of Community Health Nursing, 19(4), 213-224.
McCarthy, L. H., Bigal, M. E., Katz, M., Derby, C., & Lipton, R. B. (2009). Chronic pain and obesity in elderly people: results from the Einstein aging study. Journal of the American Geriatrics Society, 57(1), 115-119.
Mills, S., Torrance, N., & Smith, B. H. (2016). Identification and management of chronic pain in primary care: a review. Current Psychiatry Reports, 18(2), 22.
Pitcher, M. H., Von Korff, M., Bushnell, M. C., & Porter, L. (2019). Prevalence and profile of high-impact chronic pain in the United States. The Journal of Pain, 20(2), 146-160.
Kopec, J. A., & Sayre, E. C. (2004). Work-related psychosocial factors and chronic pain: a prospective cohort study in Canadian workers. Journal of Occupational and Environmental Medicine, 46(12), 1263-1271.
Vachon-Presseau, E., Berger, S. E., Abdullah, T. B., Griffith, J. W., Schnitzer, T. J., & Apkarian, A. V. (2019). Identification of traits and functional connectivity-based neurotraits of chronic pain. PLoS biology, 17(8), e3000349.