GPs' experience of managing chronic pain in a South Asian community--a qualitative study of the consultation process.

BACKGROUND: Chronic pain is one of the most common reasons for seeking primary care consultations. GPs' experience of managing patients with pain from a multicultural community has not previously been examined. OBJECTIVES: We explored GPs' experiences of managing patients with chronic pain from a South Asian community in Leicester. METHODS: Qualitative semi-structured interviews were conducted with GPs from practices in two primary care trusts within Leicester. Eighteen GPs (11 males and 7 females) were interviewed in this study. RESULTS: Several emerging themes were identified from the data including consulting behaviour, presentation of pain, GPs personal challenges, psychosomatic interpretations and communication. Overall, GPs find that managing South Asian patients with chronic pain can be challenging as a consequence of the way in which patients present with pain. Difficulties for GPs were created not only by language differences but also by cultural differences, which were not seen in second or third generation South Asians. GPs felt that self-management was difficult to address, and compliance with medication difficult to determine. In such consultations, GPs perceived that patients were more likely to present with psychosomatic symptoms. CONCLUSIONS: Cultural influences play an important role in the consultation process where patients' behaviour is often bound in their cultural view of health care. Patients' presentation of their condition makes diagnosis difficult but can also lead to miscommunication. Whether South Asian people are more likely to present mental health problems as chronic pain is not clear and warrants further investigation.

Seismic consequences of warm versus cool subduction metamorphism: examples from southwest and northeast japan

Warm and cool subduction zones exhibit differences in seismicity, seismic structure, and arc magmatism, which reflect differences in metamorphic reactions occurring in subducting oceanic crust. In southwest Japan, arc volcanism is sparse and intraslab earthquakes extend to 65 kilometers depth; in northeast Japan, arc volcanism is more common and intraslab earthquakes reach 200 kilometers depth. Thermal-petrologic models predict that oceanic crust subducting beneath southwest Japan is 300 degrees to 500 degrees C warmer than beneath northeast Japan, resulting in shallower eclogite transformation and slab dehydration reactions, and possible slab melting.