Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
How is chronic pain defined and how many people is it thought to affect?
Conventionally chronic pain is defined as pain that lasts beyond the expected period of healing. Most experts consider a pain to be chronic after three months.
Chronic pain is very common. Estimates of how common depends on exactly how it is measured. Some studies suggest it can affect half the population and others it can be as low as one in ten of the population. In some of earlier work we found that a quarter of young adults and half of those aged 55-64 had chronic pain.
What prompted your research into chronic pain amongst different ethnic groups?
When we started this work I was working as a general practitioner (family physician) in Tower Hamlets, which is a very deprived multi-cultural part of inner city London. I saw very many Bangladeshi patients with chronic pain and I wanted to find out how I could be better at helping hem manage their pain.
The first step in trying to improve care for this group is to understand the size of the problem and if there are any differences in the pain affecting Bangladeshi and White British patients.
Can you please outline what your recent study, funded by Arthritis Research UK, involved?
In this study we wanted to find out if there was a difference in how common chronic musculoskeletal pain is amongst different ethnic groups; and if the impact it had on health differed between ethnic groups.
We wrote to nearly four and half thousand people identified from 16 general (family) practices across Tower Hamlets and asked them if they had chronic pain. To ensure we were able to get information from the Bangladeshi community we had bi-lingual researchers phoning those who did not reply. This told us how common musculoskeletal pain was but not how it affected people.
To find out how it affected people we did a second study in which our bi-lingual researchers approached 600 people waiting to see the doctor or a nurse and asked them to complete a longer questionnaire for us; if necessary the researchers helped those who had difficulty reading to complete the questionnaire.
We divided the Bangladeshi population into those who grew up in the UK (British Bangladeshis) and those who grew up in Bangladesh (Bangladeshi) and compared their responses with the White British population.
What were the main findings of this research and how do you think they can be explained?
The really striking finding was how common chronic pain was. Around half of the White British and the British Bangladeshi groups had chronic pain; whilst nearly three quarters of the Bangladeshi group had chronic pain. Furthermore those with chronic pain, for all three groups, had much worse quality of life than those without pain.
We found that chronic pain is both more common and more severe in Bangladeshis in Tower Hamlets than in either British Bangladeshis or Whites. Interestingly the impact of this pain on overall quality of life was similar in all three groups
We do not know why the Bangladeshi group have more chronic pain. Whatever the reason for the pain we did not find differences in how it affected people. This suggests, contrary to our expectations, that the increased amount of pain affecting the Bangladeshi community is not culturally dependant.
How do you intend to determine the reasons behind these differences?
In a linked study we have done detailed interviews with some of our Bangladeshi participants to help us understand how and why they are affected by pain. We have nearly finished analysing these data.
What impact will this research have on GPs’ understanding of chronic pain amongst different ethnic groups?
Our data, of course, only apply to the Bangladeshi community and may not apply to all ethnic groups. The general conclusion we can draw is that chronic pain really is very common in the Bangladeshi community and that it affects this group in the same way as it does the British Bangladeshi and White British groups.
It needs to be taken just as seriously in all ethnic groups. We need to rise to the challenge of how to help this group, many of whom do not speak English to manage their pain.
Do you think the results of your study will help to improve treatment for chronic pain?
Yes! This will help emphasise the importance of making the best use of what we know about helping people live with chronic pain across all ethnic groups
Why was your research carried out in the London Borough of Tower Hamlets and are there plans to carry out similar studies elsewhere?
Partly because it was where I was working as a GP and encountered the problem every day when I was at the practice. Tower Hamlets has one of the largest Bangladeshi communities outside Bangladesh making it an important health problem.
Also because the non-White population is predominantly Bangladeshi we were able to make direct comparison between different groups living and working in a similar environment. This means it would be difficult to replicate this study in other parts of the UK.
What are your future research plans?
I am continuing work on different ways of helping people with chronic pain. We have nearly completed a large trial of supported self-management for people living with chronic pain. This recruited people both from Tower Hamlets and also from Coventry and Warwickshire where I am now based.
Other work involves helping people to choose which back pain treatment is best for them and identifying which groups of people with back pain get the greatest benefit from different treatments.
Where can readers find more information?
The full study is published in Clinical Rheumatology. Follow this link http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751214/pdf/10067_2013_Article_2286.pdf
About Professor Martin Underwood
Professor Underwood qualified in Manchester. He trained as a general practitioner in Carlisle. He has since worked as GP in Lusaka, Manchester, London, and Coventry.
Over the last 20 years he has established a substantial programme of research into the community management of chronic musculoskeletal pain. Important randomised controlled trials have shown the benefit of manual therapy, exercise, and a cognitive behavioural approach for people with low back pain.
Other work has included systematic reviewing, interview studies and population surveys. On behalf of NICE he has chaired guideline development groups on both back pain and headaches. He is now director of Warwick Clinical Trials unit and a GP in a deprived multi-cultural area of Coventry.
About Arthritis Research UK
Arthritis Research UK is the leading authority on arthritis in the UK, conducting scientific and medical research into all types of arthritis and related musculoskeletal conditions. It is the UK’s fourth largest medical research charity and the only charity solely committed to funding high quality research into the cause, treatment and cure of arthritis.