Image credit: Openclipart. Text: Author’s own.
Unpopular opinion: pain is great.
As our body’s fire alarm, it keeps us safe – it tells us when something’s not right, and keeps going until the problem is fixed. But when the alarm turns faulty and never stops ringing…not so great. For individuals with chronic musculoskeletal conditions, this rings pretty true (pun intended!).
According to the Department of Health and Social Care, as of 2023, the most deprived 20% of neighbourhoods had a greater proportion of long-term musculoskeletal condition reports than the least deprived 20%. This implies that these conditions occur more often – and potentially more severely – in deprived populations. Resulting pain also has relatively far-reaching consequences for mental health, which propels other negative outcomes on physical health and function, further worsening condition management in a vicious cycle.
How does this happen?
Being deprived presents many barriers for patients. With money going out faster than it comes in, things that promote pain-management – a bus ride to the physiotherapy clinic or a membership at the local gym – become unaffordable. With the stress of always trying to make a penny stretch as far as a pound (not forgetting the increased crime on the streets), the body ends up constantly producing an inflammatory response, obstructing healing and recovery. Ouch.
At the same time, deprivation makes a person feel bad about themselves and worry more, which precedes depression and anxiety. And just when it couldn’t get any worse…These disorders physically make pain feel more severe, while demotivating patients from engaging with pain-management strategies such as exercising or dieting. The result: even more pain.
And so, being deprived makes musculoskeletal conditions a lot harder to manage.
What we did…
To understand how condition management is affected by deprivation and mental health in more detail, we analysed the relationships using numeric data from 470 patients who had received treatment at Enfield Musculoskeletal Community Health Hub. As we also wanted to examine the richness of individual experiences of deprivation, we interviewed ten patients living in the most deprived areas who had experienced mental health difficulties during treatment. We asked patients about their conditions and how these related to their mood, then searched for themes relating to deprivation, mental health and condition management.
What we found…
Figure 1: Themes, and how they relate to deprivation, condition management and mental health
Our themes reinforced previous findings: we found a two-way relationship between experiences of condition management and mental health. Managing the condition was taxing on mental health, and poor mental health worsened the experience of condition management.
Unsurprisingly, we found that deprivation worsened both mental health and experiences of condition management separately by causing stress, limiting access to (mental and physical) healthcare services, and obstructing engagement with healthier behaviours.
Most interestingly, however, it made condition management more mentally and emotionally taxing.
Why? A closer look…
One patient, a single mother of three, couldn’t afford to hire external help for chores. Therefore, she battled the pain to complete them herself, which was extremely stressful.
“If you have someone to help you…for what you- you put yourself to it? Just take your painkiller and rest, yeah. But for me…even if take the painkiller, I have to, you know.”
When she struggled to complete chores because of the pain, it impacted her children, which also brought down her mood.
“You feel bad, you know, you feel sad…I can’t do nothing at home. Then affects them as well, yeah. They come at home. They want the food ready.”
Meanwhile, another patient with mobility issues needed to renovate his flat to get around more easily. But not owning the flat meant that crucial renovations couldn’t be made. So every day, he ended up facing the same frustrating, stressful situations.
“When I put in a chair inside, so..I can’t move it out…and after I’m hitting, you know, my arm and shoulder doing that, because no space for me…Can you imagine every time you are thinking, oh, where can I go? Where can I go?”
Most of all, he believed that unsuitable housing was the root of all his issues.
What does it all mean?
I’ll let the patient speak for himself: “When I change the house, I believe myself I will get better.” In other words, addressing deprivation can improve condition outcomes.
Beyond increasing pain and worsening mental health directly, deprivation prevents patients from managing the condition sustainably by adding to the mental health burden. On its own, condition management is already taxing, as patients must meet the demands of daily life alongside the pain. However, for deprived patients, who face more uncertainties yet have less time and money, condition management becomes exhausting, and further compromises mental health. In this way, deprivation feeds the vicious cycle between poor condition management and mental health, maintaining musculoskeletal health inequalities.
Where do we go from here?
To close this gap, policymakers must find ways to make healthy living and healthcare services more accessible to those living in deprivation. This can be done through:
- Increasing the range of chronic pain services in deprived areas
- Encouraging patient disclosure of individual psychosocial factors during clinics and discussion of how they may impact treatment outcomes
Notably, interviews mainly took place in person at the hub, which requires time, mobility and finances for interviewees to access. As such, it’s possible that those who declined to participate had different demographics, health characteristics and experiences that our data does not reflect. Hence, further research with greater consideration of accessibility needs is necessary to capture this patient group’s experiences.
thanks for info.