Backache in Greek Immigrants to Sweden: A Cultural Interpretative Approach

Abstract

Scandinavian medical methods for treating musculoskeletal pain have often proved unsuccessful with immigrant patients. This study examined the perception and meanings of back pain among Greek immigrants to Sweden to identify possible causes of this poor outcome. Fifteen Greek immigrant patients on long-term sick-leave because of backache and 21 strategi cally selected members of a Greek cultural association in Stockholm, Sweden, not on sick-leave received semi-structured interviews about backache. In addition to a content analysis, a cultural approach was used in the interpretation of the mate rial. On the whole, pain was considered as something dangerous, inevitably leading to permanent disability if the suf ferer should deliberately aggravate the pain. Persistent pain was also linked to the tendency to worry and obsess in a way that would eventually make one ill. There was little confidence in doctors' examinations and physiotherapy. The study provides a possible explanation as to why Scandinavian medical treat ment of backache is less successful in this immigrant group.

Pain intensity and severe pain in young immigrant patients with long-standing back pain

“…Also included in the initial assessment was a semistructured interview about concepts of pain [22]. Data from the interview was not used here.…”

“…Many women here seemed to have escalated pain intensity caused rather by frightful ideas than sad mood [3], in contrast to most men. Pain related fears were particularly common among Turkish patients implying the sharing of frightening concepts of pain in this community where relatives, neighbors and friends offer support while spreading notions around illnesses [15,22,40]. Further, some of the patients, both men and women, at first displayed an angry attitude.…”

“…Some patients find it hard to explain locations and intensity of chronic pain [20,37], leading to difficulties for health care personnel [18], not least in cross-cultural settings [6,9,15,22]. Some health professionals have remarked on how differently patients from various cultural groups (immigrant groups) declare how much it hurts in spite of similar clinical findings [7,22,32].…”

“…Some health professionals have remarked on how differently patients from various cultural groups (immigrant groups) declare how much it hurts in spite of similar clinical findings [7,22,32]. Further, patients' reported pain intensity influence doctors' sick listing practices [10] as possibly reflected in the Swedish census on sick leave where some groups of young women seem more disabled from chronic pain than other women [38].…”

“…Some health professionals believe that these patients deliberately exaggerate pain (personal comments). However, severe pain could also be attributed to learned factors [6,26,36], to work load [19], emotional distress [2,12,21,22] or doctor-patient interactions [15].…”