Experiences of Assyrian refugee women seeking care for chronic pain: a qualitative study.

BACKGROUND: Refugee women exhibit some of the highest rates of chronic pain yet the diversity and challenges of health care systems across countries pose numerous challenges for refugee women trying to access quality health care. OBJECTIVE: We sought to explore the experiences of Assyrian refugee women seeking care for chronic pain. METHODS: Semi-structured interviews (face-to-face and virtual) were undertaken with 10 Assyrian women of refugee background living in Melbourne, Australia. Audio recordings and field notes of interviews were collected and themes were identified using a phenomenological approach. Women were required to be conversant in English or Arabic and willing to use a translator if necessary. RESULTS: We identified five major themes of women's experiences accessing care for chronic pain: (1) the story of pain; (2) the experience of help seeking in Australia and home country; (3) factors shaping the ability to access appropriate care; (4) support seeking systems; and (5) influence of culture and gender roles. CONCLUSION: Exploring refugee women's experience of seeking care for chronic pain reinforces the need to explore hard to reach population's perspectives in research and helps to understand how vectors of disadvantage may intersect. For successful integration into health care systems of host countries, particularly for complex conditions such as chronic pain, there is a need to work with women community members to develop programs that are culturally aligned to enhance access pathways to care.

The association between chronic pain and pre-and-post migration experiences in resettled humanitarian refugee women residing in Australia.

BACKGROUND: Refugee women are potentially at increased risk for chronic pain due to circumstances both in the pre-migration and post-settlement setting. However, this relationship between refugee-related challenges introduced along their migration trajectories and chronic pain remains unclear. This study will therefore examine the association between pre- and post-migration factors and chronic pain in refugee women five years into resettlement in Australia. METHODS: The first five waves of data from the 'Building a New Life in Australia' longitudinal study of humanitarian refugees living in Australia was analysed using logistic regression models to investigate the association between predictor variables and chronic pain. The study outcome was chronic pain and predictors were migration process and resettlement factors in both the pre-and post-settlement setting. RESULTS: Chronic pain was reported in 45% (n = 139) of women, and among these a further 66% (n = 120) also reported having a long-term disability or health condition that had lasted 12 months. Pre- migration factors such as increasing age (OR 1.08; 95% CI 1.05, 1.11) and women who migrated under the Women at Risk Visa category (OR 2.40; 95% CI 1.26, 4.56) had greater odds of experiencing chronic pain. Interestingly, post migration factors such as women with better general health (OR 0.04; 95% CI 0.01, 0.11) or those who settled within metropolitan cities (OR 0.29; 95% CI 0.13, 0.68) had lower odds of experiencing chronic pain, and those who experience discrimination (OR 11.23; 95% CI 1.76, 71.51) had greater odds of experiencing chronic pain. CONCLUSION: Our results show that there is a high prevalence of chronic pain in refugee women across the initial years of resettlement in Australia. This may be in part due to pre-migration factors such as age and migration pathway, but more significantly the post migration context that these women settle into such as rurality of settlement, poorer general health and perceived discriminatory experiences. These findings suggest that there may be many unmet health needs which are compounded by the challenges of resettlement in a new society, highlighting the need for increased clinical awareness to help inform refugee health care and settlement service providers managing chronic pain.

Pre- and post-migration factors associated with chronic pain in humanitarian refugee women living in Australia: A protocol study.

BACKGROUND AND OBJECTIVES: Refugee women exhibit some of the highest rates of chronic pain, but the relationship between chronic pain and refugee-related challenges arising from migration trajectories remains unclear. This article outlines the study protocol for a secondary analysis that seeks to identify pre- and post-migration factors associated with chronic pain and long-term disability in refugee women five years into resettlement in Australia. This study will examine the association between migration factors and chronic pain in refugee women five years into resettlement in Australia. METHOD: This protocol design uses data from Building a New Life in Australia, a prospective longitudinal cohort study. The primary outcome is chronic pain in refugee women resettled in Australia. The variables of interest are pre- and post-migration factors, which have been categorised using a model adapted from a conceptual framework of social determinants of health. A two-step process of univariate and multivariate logistic regression analysis will be used to examine associations. A subset analysis of factors associated with chronic pain in women who report a long-term disability will also be investigated DISCUSSION: Outcomes of this research will inform existing resettlement services to promote or improve chronic pain management for refugee women.

Evaluating chronic pain interventions in recent refugees and immigrant populations: A systematic review.

OBJECTIVES: Many studies investigating the management of chronic pain often exclude participation of people from refugee and immigrant backgrounds. This review seeks to understand and evaluate the effectiveness of interventions for chronic pain management when applied in the context of refugee and immigrant populations. METHODS: A systematic review was undertaken using six databases and the PICO search strategy. Included studies were published in English, comprised of patients over 18 years of age and excluded cancer-related chronic pain. RESULTS: Twenty-one papers met the inclusion criteria: 13 cohort studies and eight randomised control trials. The majority of interventions involved multidisciplinary or psychological interventions, with the remaining studies based on education, exercise therapy or culturally adapted information. Studies integrating multidisciplinary care to manage chronic pain showed more consistent improvements in pain intensity and function than other unimodal interventions. CONCLUSIONS: Multidisciplinary interventions reduce pain intensity, improve functional impairment, and alleviate other psychosocial symptoms exhibited chronic pain patients from refugee or immigrant backgrounds. Additional well-designed, large-scale studies are needed to decisively estimate the effectiveness of culturally adapted, multidisciplinary intervention programs over time. PRACTICE IMPLICATIONS: Clinical practice may benefit from adapting interventions to better support the management of chronic pain in refugee and immigrant populations.