Chronic Musculoskeletal Pain Experiences of First Generation, Middle Aged Somali Women: A Descriptive Qualitative Study

Abstract

Chronic pain is one of the most prevalent and costly health conditions in the United States. In refugees and immigrants, chronic pain is more prevalent and the severity of pain is higher. Musculoskeletal chronic pain is one the most common forms of pain that refugees and immigrants experience. In collaborating with a local community clinic, practitioners shared that middle-aged Somali women experienced a high incidence of non-specific musculoskeletal chronic pain that practitioners struggled to address through typical treatment measures. In a review of the literature it was found that no studies described chronic musculoskeletal pain for middle-aged Somali women, nor factors that contribute to their interpretation and management of pain. To date, there are no studies that specifically address chronic musculoskeletal pain in a refugee group in the United States, and few studies utilized a social ecological approach to describe the influence of environmental, societal, and immigration experiences in the management of pain. In this community-informed, descriptive qualitative study, musculoskeletal chronic pain experiences of first-generation, middle aged (40-65) Somali women living in the Minneapolis-St. Paul area are described. Utilizing the social ecological model and the dynamic biopsychosocial model, twelve core themes emerged that show the biological, psychological, social, and environmental factors that influenced participant experiences with pain. For Somali women in this study, the physical sensation of pain originated in the biological level and extended through the psychological and social levels of the microsystem. This physical experience of pain created a catalyzing influence that extended across the levels of the social ecological model. The core themes were: physical experience of pain, daily function and career, self-care practices, emotional experience of pain, recommendations for others experiencing pain, recommendations for community and clinics in treating pain, relationships with others, experience accessing care, financial impact, insurance affect, religious practice, traditional medicine and country of origin pain management, and sociopolitical issues. For these seventeen, first-generation, middle aged Somali women, pain was complex and multidimensional, and the physical experience of pain was only one aspect of chronic pain experience. Sociopolitical experiences were profound and triggered worry and fear that influenced pain. Insurance & financial issues compounded complexity with chronic pain management. Traditional medicine, memory of Somalia, and experience in Somalia were valuable resources and points of reference for managing pain. Pain influenced a Somali woman’s ability to secure a steady job. Pain management strategies were diverse and included integrative modalities. Religious practice was a key resource to pain management and overall pain experience. Participants sought alternatives to medications and used medications when necessary; and recommended and used exercise to manage pain. Health care providers played a key role in Somali women’s pain management. Many of these findings aligned with previous literature; however, the extensive multidimensionality of pain across the levels of the social ecological model is a new finding that should be further studied. In addition, further research is needed to expand knowledge related these findings and their potential to be generalized to other Somali women and men, and immigrants and refugees from other countries. In particular, to explore and define “Pain all over”, to investigate practitioner experiences in working with Somali patients and pain and how they approach the clinical interaction, and to examine outcomes of religious practice in pain-management. The implications of this research are several. Findings suggest the importance of story in working with Somali women to understand the meaning and cause of pain, in addition to the positive influence of health care providers when participants felt heard. Insights into how discrimination and an intense sociopolitical climate may influence the health and well-being of Somali women also emerged. Concerns were raised on language interpretation services and a need for further oversight and regulation was identified, in addition to the barriers participant’s experienced in understanding the ever-changing insurance landscape. More effort is needed to educate the greater community on experiences of immigrants and refugees in order to make informed changes in our communities, health systems, and political environment. These findings show that this social ecological approach to chronic pain treatment and management may be helpful in understanding the lived experience of pain for Somali women.