Group Differences Between Countries and Between Languages in Pain-Related Beliefs, Coping, and Catastrophizing in Chronic Pain: A Systematic Review

Abstract

Objective To evaluate the extent to which pain-related beliefs, appraisals, coping, and catastrophizing differ between countries, language groups, and country economy. Design Systematic review. Methods Two independent reviewers searched 15 databases without restriction for date or language of publication. Studies comparing pain beliefs/appraisals, coping, or catastrophizing across two or more countries or language groups in adults with chronic pain (pain for longer than three months) were included. Two independent reviewers extracted data and performed the quality appraisal. Study quality was rated as low, moderate, or high using a 10-item modified STROBE checklist. Effect sizes were reported as small (0.20–0.49), medium (0.50–0.79), or large (≥0.80). Results We retrieved 1,365 articles, read 42 potential full texts, and included 10 (four moderate-quality, six low-quality) studies. A total of 6,797 adults with chronic pain (33% with chronic low back pain) were included from 16 countries. Meta-analysis was not performed because of heterogeneity in the studies. A total of 103 effect sizes were computed for individual studies, some of which indicated between-country differences in pain beliefs, coping, and catastrophizing. Of these, the majority of effect sizes for pain beliefs/appraisal (60%; eight large, eight medium, and eight small), for coping (60%; seven large, 11 medium, and 16 small), and for catastrophizing (50%; two medium, one small) evidenced statistically significant between-country differences, although study quality was low to moderate. Conclusions In 50% or more of the studies, mean scores in the measures of pain beliefs and appraisals, coping responses, and catastrophizing were significantly different between people from different countries.

How do people in China think about causes of their back pain? A predominantly qualitative cross-sectional survey

“…We have also attempted to address any potential issues by not overstating the comparisons between the ndings of the two studies. The different belief system of LBP population in China found in our study, supports research that suggests that cultural factors in uence pain-related factors (19,33,34,61,63). For example, in contrast with the overwhelming LBP medical care in the West (14,25,32), a Nepalese study showed that people who suffered from LBP continued with their daily activities without seeking medical help as they consider LBP to be a normal aging process (61).…”

“…Due to the lack of data from less-developed China, the study ndings may not be as representative of those parts of China. Moreover, pain beliefs in uenced by culture are hard to separate from socioeconomic factors (34,61). As we did not gather participants' socioeconomic status or educational level in this study, our study ndings should be interpreted with caution with respect to representativeness.…”

“…In contrast to our ndings about patients living in China, other research suggests that Chinese healthcare professionals (57,58) show higher levels of fear avoidance beliefs related to physical activities than Western physicians (59) and medical specialists (60), and Chinese nurses have pessimistic views about LBP as many nurses experiencing LBP planned to quit their job due to their back pain (57). However, we suggest that these comparisons (57-60) should be viewed with caution as those other studies used variables developed from Western ways of thinking to quantify pain-related beliefs (34). Moreover, the overuse of MRI in diagnosing LBP in Chinese hospitals may imply that Chinese care providers are grounded in biomedical causes for LBP (13).…”

Differences in Psychological Characteristics Between People With Knee Osteoarthritis From Japan and Australia

“…We therefore hypothesized that people from Japan with knee OA would present higher fear of movement. Health professionals in many countries, including Japan, tend to advise people to rest in response to pain, rather than continue activity [15]. Advice to rest in response to pain may foster avoidance beliefs relating to pain [40], yet runs counter to evidence for effective knee OA management [41].…”

“…However, these studies were performed within a single (Western) population. Further, recent systematic reviews reporting differences in pain-related beliefs and pain catastrophizing between countries included data mostly from Western populations, with the exception of one Asian population (Singapore) [14,15]. Little is known about the differences in psychological characteristics among people with knee OA living in different counties, in particular between those living in Western countries (e.g.…”