Background Available evidence shows that the experience and perception of pain varies among different populations. Further, inequalities are reported in pain treatment across various types of pain and in different settings (1). In particular, it is unknown how much immigrants in Western European countries profit from pain management programs.
Objectives The aim of this study was to detect differences in the course of Italian- and German-speaking patient's state of health and quality of life after a 4-week standardized interdisciplinary pain management program in German or in Italian.
Methods The prospective cohort study with 61 Italian-speaking and 63 German-speaking patients with fibromyalgia or chronic back pain measured health-related quality of life, pain, anxiety and depression comparing at baseline, after 4 weeks of pain program and at 1 year follow-up. Differences between the two groups were tested on significance by generalized estimation equations (GEE) (2). This method modeled changes of health by multivariate logistic regression adjusting for sex, education, number of comorbidities and the baseline score over both follow-ups for each scale.
Results Italian-speaking patients (n=61) showed higher proportions of males, lower educated and less burdened by comorbidities than German-speaking patients (n=63). At baseline, physical and psychosocial health, depression and anxiety of the Italian-speaking patients were worse than German-speaking patients, with the exception of less pain in the Italian-speaking patients on the SF-36. Changes of health showed more improvement in German- than in Italian-speaking patients on all scales and at both follow-ups. In GEE, the highest differences were observed in SF-36 physical functioning (p=0.035), HADS anxiety (p=0.038) and HADS depression (p=0.023). On SF-36 bodily pain, the difference was not significant (p=0.166).
Conclusions This study detected that short- and midterm outcome of Italian-speaking patients was worse than that of German-speaking patients, even after adjustment for baseline differences. The reasons for this study's results remain unclear, but may have consequences for future management of Italian-speaking patients in interdisciplinary pain management programs. Considering language as a proxy for acculturation, this supports the hypothesis that patients with lower level of acculturation may have special needs in therapeutic management. A cultural sensitive approach in a multidisciplinary pain program might enhance the positive outcome in the short- and mid-term (3).
Green CR, Anderson KO, Baker TA, Campbell LC, Decker S, Fillingim RB, Kalauokalani DA, Lasch KE, Myers C, Tait RC, Todd KH, Vallerand AH. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med 2003;4:277–94.
Twisk JW. Generalized estimating equations. Applied longitudinal data analysis for epidemiology. 2nd ed. Cambridge: Cambridge University Press; 2013: p 57–68.
Benz T, Lehmann S, Brioschi R, Elfering A, Aeschlimann A, Angst F. Comparison of short- and mid-term outcome of Italian- and German-speaking patients after an interdisciplinary pain management program. Disabil Rehabil 2017; in preparation.
Disclosure of Interest None declared