The influence of cultural and religious factors on cross-national variations in the prevalence of chronic back and neck pain: an analysis of data from the global burden of disease 2019 study

Abstract

IntroductionLow back pain and neck pain are among the most commonly reported forms of chronic pain worldwide, and are associated with significant distress, disability and impairment in quality of life. Though these categories of pain can be analyzed and treated from a biomedical perspective, there is evidence that they are both related to psychological variables such as depression and anxiety. The experience of pain can be significantly influenced by cultural values. For example, cultural beliefs and attitudes can influence the meaning attached to the experience of pain, the responses of others to a sufferer's pain, and the likelihood of seeking medical care for particular symptoms. Likewise, religious beliefs and practices can influence the both experience of pain and the responses to it. These factors have also been associated with variations in the severity of depression and anxiety.MethodsIn the current study, data on the estimated national prevalence of both low back pain and neck pain, obtained from the 2019 Global Burden of Disease Study (GBD 2019), is analyzed in relation to cross-national variations in cultural values, as measured using Hofstede's model (n =115 countries) and in religious belief and practice, based on the most recent Pew Research Center survey (n = 105 countries). To address possible confounding factors, these analyses were adjusted for variables known to be associated with chronic low back or neck pain, namely smoking, alcohol use, obesity, anxiety, depression and insufficient physical activity.ResultsIt was found that the cultural dimensions of Power Distance and Collectivism were inversely correlated with the prevalence of chronic low back pain, and Uncertainty Avoidance was inversely correlated with the prevalence of chronic neck pain, even after adjustment for potential confounders. Measures of religious affiliation and practice were negatively correlated with the prevalence of both conditions, but these associations were not significant after adjusting for cultural values and confounders.DiscussionThese results highlight the existence of meaningful cross-cultural variations in the occurrence of common forms of chronic musculoskeletal pain. Psychological and social factors that could account for these variations are reviewed, along with their implications for the holistic management of patients with these disorders.

The predicting factors of chronic pain among nursing students: a national study in Iran

“…These differences may be due to the collectivist cultural context, as opposed to the individualistic culture, of these populations and their different training programs. The focus of physical exercises on back pain management among physiotherapy students may reduce their fear of exercising and increase their positive adaptive behaviors regarding back pain [ 60 ].…”

“…On the other hand, in European and North American countries, individualism is the dominant culture [ 61 ]. Cultural differences between collectivist and individualistic societies affect their rate of depression, emotional response to pain [ 43 ], and adjustment to stress and inconveniences, which can have an impact on individuals’ experience of pain, expression of pain, and response to pain [ 60 ]. As integral parts of a culture, religion and spirituality can facilitate adaptation to pain and reduce negative feelings, such as depression, which potentially aggravate pain [ 62 ].…”

“…As integral parts of a culture, religion and spirituality can facilitate adaptation to pain and reduce negative feelings, such as depression, which potentially aggravate pain [ 62 ]. Collectivist cultural values may positively correlate with such key psychological processes as self-adjustment, which can affect both the perception of musculoskeletal chronic pains and the associated disabilities [ 60 ]. It appears that collectivism can be a protective factor against chronic back pain and neck pain.…”

Improving Rehabilitation Research to Optimize Care and Outcomes for People with Chronic Primary Low Back Pain: Methodological and Reporting Recommendations from a WHO Systematic Review Series

“…Contextual factors like cultural variations and individual preferences can influence treatment outcomes [ 49 ]. The impact and meaning of living with or without a disability can differ among individuals based on their cultural backgrounds and personal circumstances [ 50 , 51 ]. These cultural nuances manifest in attitudes toward disability, support system availability, and societal expectations of independence or interdependence.…”

“…Contextual factors also interact with treatments, modifying their effects or mediating patient responses [ 53 ]. Treatment effectiveness can vary across cultural contexts, influenced by factors, such as belief systems, spirituality, religion, attitudes, and social support systems [ 50 , 51 ]. As a result, the conventional approach of combining study results in meta-analyses may oversimplify the complexities of interventions in diverse contexts.…”