Socioeconomic Status and the Course and Consequences of Chronic Pain

Abstract

This article consists of a brief overview of the relationship between chronic pain (CP) and socioeconomic status (SES), a review of recent studies conducted in 2010 and then a discussion of the psychological meaning of the findings in light of wider under standing about SES and health [Bonathan C, Unpublished Data]. Chronic or persistent pain affects people across their lifespan, with significant impact on all aspects of life. It is associated with economic and social disadvantage [1], loss of work [2] and reduced work effectiveness [3]. The risk factors for CP are similar to those for many chronic health conditions [4], but while sex and age are routinely considered, less attention is paid to unhealthy behaviors, such as smoking [5], and to other markers of SES. The biopsycho social model describes interacting factors in the onset, experience and outcome of CP. It pays particular attention to the role of emotional states, health beliefs and pain-related behaviors [6]. The social aspects are arguably the least explored [3], and this article focuses on an important aspect of the social environment; SES. There are two dimensions: economic (financial and material wealth) and social (such as education and community standing). Socioeconomic factors, such as lower levels of education, low income and unemployment are associated with higher rates of chronic and disabling pain [7]. However, the nature of the relationship between chronic pain and SES is unclear. Review methods Given that a thorough review was conducted in 1998 [8], we searched for papers examining the link between chronic pain and SES dated from 1998 to the present time. Databases such as PsycINFO, MEDLINE and Embase were used. Searches for references of relevant papers, combining terms, such as chronic and persistent pain, and all categories of SES were carried out. Of the 143 studies retrieved, 75 measured only partial aspects of SES and/or did not explore its relationship with chronic pain, 39 described treatment outcome, and 22 fell short of the inclusion criteria in other ways. This left seven studies, to which six were added from reference lists of reviews. Adjusting and rerunning the search with terms used in these studies (e.g., ‘disabling pain’) produced no new studies.