“I'm healthy, I don't have pain”- health screening participation and its association with chronic pain in a low socioeconomic status Singaporean population

BACKGROUND: We sought to determine the association between chronic pain and participating in routine health screening in a low socioeconomic-status (SES) rental-flat community in Singapore. In Singapore, ≥ 85% own homes; public rental flats are reserved for those with low-income. METHODS: Chronic pain was defined as pain ≥ 3 months. From 2009−2014, residents aged 40−60 years in five public rental-flat enclaves were surveyed for chronic pain; participation in health screening was also measured. We compared them to residents staying in adjacent owner-occupied public housing. We also conducted a qualitative study to better understand the relationship between chronic pain and health screening participation amongst residents in these low-SES enclaves. RESULTS: In the rental-flat population, chronic pain was associated with higher participation in screening for diabetes (aOR = 2.11, CI = 1.36−3.27, P < 0.001), dyslipidemia (aOR = 2.06, CI = 1.25−3.39, P = 0.005), colorectal cancer (aOR = 2.28, CI = 1.18−4.40, P = 0.014), cervical cancer (aOR = 2.65, CI = 1.34−5.23, P = 0.005) and breast cancer (aOR = 3.52, CI = 1.94−6.41, P < 0.001); this association was not present in the owner-occupied population. Three main themes emerged from our qualitative analysis of the link between chronic pain and screening participation: pain as an association of “major illness”; screening as a search for answers to pain; and labelling pain as an end in itself. CONCLUSIONS: Chronic pain was associated with higher cardiovascular and cancer screening participation in the low-SES population. In low-SES populations with limited access to pain management services, chronic pain issues may surface during routine health screening.

Chronic Pain in a Low Socioeconomic Status Population in Singapore: A Cross-Sectional Study.

PURPOSE: . The authors sought to determine the prevalence of chronic pain in a low socioeconomic-status rental-flat community in Singapore and its associations. In Singapore, ≥85% own homes; public rental flats are reserved for the low-income. METHODS: . Chronic pain was defined as pain ≥3 months. From 2009-2014, residents aged ≥ 40 years in five public rental-flat enclaves were surveyed for chronic pain, as well as sociodemographic factors. Subsequently, the authors conducted an additional study among elderly (aged ≥60) in two public rental-flat enclaves in 2012. The authors compared against residents staying in adjacent owner-occupied public housing. RESULTS: . Prevalence of chronic pain in the rental-flat population was 14.2% (133/936) compared with 14.4% (158/1101) in the owner-occupied population (p = 0.949). On multivariate analysis, among those aged 40-59 years, staying in the rental flat community was independently associated with higher prevalence of leg/ankle/foot pain, compared to staying in the owner-occupied flat community (aOR = 2.35, CI = 1.24-7.35, p = 0.008). In the rental-flat population, unemployment was associated with chronic pain (aOR = 1.92, 95%, CI = 1.05-2.78, p = 0.030); among the elderly, dependency in instrumental-activities-of-daily-living (iADLs) was associated with chronic pain (aOR = 2.38, CI = 1.11-5.00, p = 0.025), as well as female gender, being single, and having higher education (all p > 0.05). CONCLUSIONS: . In this low socioeconomic-status population, chronic pain associated with unemployment and functional limitation. There was no difference in pain prevalence between the rental-flat population and adjacent owner-occupied precincts.