Abstract
BackgroundThe prevalence of self-identified chronic pain in Canadian adults is approximately one in five people. Marginalization and addictions have been shown to complicate chronic pain in vulnerable populations. This study aimed to understand the experience of chronic pain among female Survival Sex Workers in Vancouver's downtown eastside (DTES).MethodsThis study used an exploratory qualitative analysis with in-depth, semi-structured interviews. Members of PACE Society who self-identified as a current or former Survival Sex Worker and who had a chronic pain experience known to PACE support workers were invited to participate. Interviews were conducted, audio recorded and transcribed. The investigators met to read the transcripts and discuss emerging themes. The process continued until no new themes were observed.ResultsParticipants ranged in age from 42 to 56 years old and all self- identified as females and Survival Sex Workers. Eleven of thirteen interviews were analyzed for themes. Drug use for pain management, both prescribed and illicit, was the most important theme. Poverty, the need to continue working and the lack of stable housing were barriers to adequately addressing the source of chronic pain. Participants felt judged for living in the downtown eastside, being a drug user and/or being Aboriginal and only two participants had been referred to a pain specialist. All participants were involved in support networks made up of other Sex Workers and all spoke of a sense of community and survival.ConclusionsOur study emphasizes the complex nature of chronic pain and addictions among a uniquely marginalized population. The study is unique in that it contributes the perspectives of a traditionally “hard-to-reach” population and demonstrates that Sex Workers should not only participate in but should lead development and implementation of research and programs for managing chronic pain in the setting of addiction.
Highlights
The prevalence of self-identified chronic pain in Canadian adults is approximately one in five people
If chronic pain is seen as being temporally related to a painful stimulus that should resolve with treatment of that stimulus, if addiction is seen as a choice and non-compliance viewed as a psychological or biological factor, we incorrectly focus our energies on changing the patient
With a chronic pain and addictions paradigm that shifts from a biologic understanding of dyscompliance to an understanding of the social factors, cultural, political and economic factors that contribute to a perceived non-compliance, we can begin to address the multiplicity of factors that have failed this population in the first place and continue to feed a culture of stigma around chronic pain and addictions [26]
Summary
The prevalence of self-identified chronic pain in Canadian adults is approximately one in five people. Allen et al BMC Family Practice (2015) 16:182 its parts, that is, pain that persists well after the original insult has healed, leaving long-lasting abnormal sensory findings secondary to changes in how peripheral nerves, spinal cord and brain react to non-noxious stimuli [3]. Based on this paradigm, a key component to understanding chronic pain, what initiates, perpetuates and alleviates it, means placing the individual pain experience within the larger social, political and economic climate [5]. Survival sex work in Vancouver’s downtown east side is primarily street based and subject to this federal criminal law
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