Pain drawings, interpreter support and clinical findings among immigrant patients on sick leave in Swedish primary health care

摘要

Aim: To evaluate the spread of pain and its correlates among immigrant patients on sick leave.Background: Backache, outspread pain and sick-leave questions are problematic to handleprimary health care, especially in multicultural settings. Methods: Two hundred and thirty-fivepatients 20–45 years on paid sick leave (59% women, 93% foreign-born, mostly nonEuropeans).Many had little formal education. One-third had professional interpretersupport. The patients pointed out on their bodies where they felt pain. This informationwas transferred on a pain drawing [pain drawing fields (PDFs) 0–18] by a doctor. Major depressionand psychosocial stressors were assessed using Diagnostic and Statistical Manual of MentalDisorders. Nociceptive locations for pain were established (pain-sites 0–18). Dependent variablewas the number of PDFs. Independent variables were social data, sick leave, interpreter, depression,stress levels and number of pain sites. Calculations were done using descriptive methodsand multi-variable linear regression in full models, by gender. Findings: Many patients haddepression (51% women versus 32% men). A majority were exposed to psychosocial stressors.Women had more PDFs, in median 5 [inter-quartile ranges (IQR) 4–8] versus men 3 (IQR 2–5),and also more pain sites, in median 3 (IQR 2–5) versus men in median 2 (IQR 1–3). For men,the regression calculations revealed that numbers of PDFs associated only with increasingnumbers of pain sites (B 0.871 P 0.001). For women, this association was weaker (B 0.364,P 0.001), with significant values also for age (B 0.103) and sick leave one year (B 0.767,P = 0.010), and a negative predicting value for interpreter support (B ?1.198, P 0.043). Toconclude, PDFs associated often with somatic findings but varied much among the women.This implies potential problems regarding cause, function and sick leave questions.However, support by professional interpreters may facilitate a shared understanding withimmigrant women having long-standing pain.