Attitudes towards pain and return to work in young immigrants on long term sick leave

Abstract

Objective - To explore attitudes towards pain and returning to work in young immigrants on long term sick leave because of chronic pain. Design - As a part of a randomised-controlled rehabilitation programme for immigrants 16- 45 years of age on sick leave > 6 weeks, the participants in the experimental group were interviewed about their attitudes towards their pain. Setting - A primary health care centre in an immigrant district in Stockholm, Sweden. Subjects - Twenty-six first generation immigrants with long-standing musculoskeletal or imprecise pain. Measures - Semi-structured interviews of explanatory models of pain. The content of the interviews was abstracted and categorised, with the focus on factors that might influence the rehabilitation process and especially cause pain anxiety. Results - The majority of the interviewees were Turks and Southern Europeans with a median age of 38.5 years and a median sick leave of 12.0 months. Nearly all assessed themselves as having no capacity to work and two-thirds reported pain anxiety. The shared characteristics of the attitude to pain were that rest is the best treatment and that occupational work is the main etiological factor for the pain. A difference was found regarding the meaning of the pain, with one cluster of interviewees focusing on a disorder (Type I attitudes) and the other duster focusing on the pain sensation itself (Type II attitudes). These dusters were equally large and there were no significant differences regarding ethnicity, religion, or other data between them. However, persons in the Type II cluster were generally more fatalistic about their future health and significantly more were working, at least part-time, at the 3 (p < 0.05) and 8 month (p < 0.01) follow-ups. Conclusion - Differences in attitudes towards pain and in qualities of pain anxiety, either focusing on the meaning of pain and its consequences or on the immediate experience of pain, might influence rehabilitation.