Using ’White Flags’ to categorize socio-cultural aspects in chronic pain

Abstract

Abstract Issue Persistent chronic pain is a major medical and health economic problem. To assess the individual pain situation, the classification of various factors (flags) has been established. Description of the problem Structural biomechanical factors are classified as “red flags”. Psychological or behavioral factors are summarized as “yellow flags”, psychiatric and mental illness as “orange flags”. Both last flags are important for planning adequate therapies or rehabilitation, as well as for decisions to prognoses and tailored reintegration programs. An extension of the flag model was achieved by naming personal factors at workplace as “blue flags”, and “black flags”, if there is a restriction for returning to work. All these groups do not consider other important reasons for unsuccessful rehabilitation or failed reintegration. Results In these cases, often described as ’therapy-refractory’, clients often exhibit a special subjective understanding of illness that reacts neither to psychological interventions nor to behavioral therapies. These include individual beliefs based, for example, on cultural socialization, religious education, or spiritual experiences. Since such individual mental illnesses are culturally ideologically or religiously justified, they should be classified in a separate group called ’white flags’. Lessons The advantages of categorizing sociocultural aspects separately from other flag classifications are avoidance of unnecessary therapies, including surgery,prevention of iatrogenisation,prevention of legal disputes. It is important to realize that only health restrictions for insurance benefits can be taken into account and that individual socio-cultural circumstances or health convictions are not evaluated. Main messages: A classification of ’white flags’ could contribute to a better classification of pain which are not accessible to various therapies and reduce reservations and misunderstandings by intercultural communication approaches. Key messages For medical professions it is important to recognize, that only health inabilities are taken into account for insurance compensation and not individual socio-cultural circumstances or health beliefs. In Future classifying ’white flags’ could help to properly assess persistent pain conditions.