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

• Published in: The Korean journal of pain Vol. 30; no. 1; pp. 34 - 43
• Main Authors: Wee, Liang En, Sin, David, Cher, Wen Qi, Li, Zong Chen, Tsang, Tammy, Shibli, Sabina, Koh, Gerald
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Pain Society 01.01.2017; 대한통증학회
• Subjects: Original; 마취과학; Health screening; Qualitative; Low-income; Mixed methods; Asian; Chronic pain
• ISSN: 2005-9159; 2093-0569
• DOI: 10.3344/kjp.2017.30.1.34

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. 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. In the rental-flat population, chronic pain was associated with higher participation in screening for diabetes (aOR = 2.11, CI = 1.36-3.27, < 0.001), dyslipidemia (aOR = 2.06, CI = 1.25-3.39, = 0.005), colorectal cancer (aOR = 2.28, CI = 1.18-4.40, = 0.014), cervical cancer (aOR = 2.65, CI = 1.34-5.23, = 0.005) and breast cancer (aOR = 3.52, CI = 1.94-6.41, < 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. 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.