Barriers to optimal chronic pain management in refugees: a scoping review

Abstract

Background: In 2023, there were 36.4 million refugees worldwide, many of whom experience physical injuries, human rights abuses and psychological distress during displacement. However, their healthcare needs during and after resettlement are rarely met. Among them, chronic pain and its effective management, are under-recognized but prevalent problems of humanitarian care. The aim of this scoping review was to improve our understanding of the challenges in treating and managing chronic pain in refugee populations. Specifically, this scoping review aims to address the following objectives: (i) to identify and systematically map available evidence in the literature on chronic pain treatment for refugees (ii) to identify barriers to optimal pain management for refugees, and (iii) identify gaps within the knowledge base. Methods: Systematic searches were conducted in five online databases to identify studies that examined or described treatment of chronic pain in refugees. Narrative analysis was conducted to describe the relevant themes extracted from the included literature. Results: 28 English-language articles were included, from which two general themes were identified regarding chronic pain treatment in refugees: (i) Pain Severity, and (ii) Psychological Correlates of Pain. Three themes were identified relating to barriers to optimal chronic pain management for refugees: (i) Sociocultural Considerations, (ii) Access to Adequate Healthcare and Medication, and (iii) Integrative Pain Management Interventions. Literature and practice gaps in the literature were also elaborated. Conclusion: It is essential to address barriers to optimal chronic pain management through multidisciplinary approaches that prioritize cultural competence and are tailored to the unique pre- and post-migration experiences of refugees. Furthermore, high-quality controlled studies are needed to investigate the effectiveness of context-specific multidisciplinary pain management interventions.