Pain amongst ethnic minority groups of South Asian origin in the United Kingdom: a review.

There has been a considerable amount of literature implying a group of people with a shared distinctive culture and a common language, and as such represents published on different aspects of health in ethnic minority groups resident in the UK [1]. The central issue of a shared national identity. In considering both the reporting of pain and consultation patterns, such ‘nonsuch health research has been on the differential occurrence of specific diseases or medical conditions in ethnic biological’ cultural factors may be particularly important. minority groups in relation to indigenous UK populations. Such differential rates of occurrence may, through In the UK, ethnic minority groups represent almost 5% of the total population. It is evident from reviewing epidemiological investigation, provide clues to the aetiology of disease. The main aim of this article is to the literature that consultation patterns, reporting of pain and co-morbidities such as psychiatric distress vary review research carried out investigating ethnicity and the experience of pain and related health-seeking behaviconsiderably between different ethnic minority groups (e.g. Afro-Caribbean and South Asian ethnic groups our in individuals of South Asian origin resident in the UK. First, the review will determine whether there is have been documented as having very different rates of psychiatric morbidity [3, 4]). For this reason, the current any evidence for differential rates in the occurrence of pain in ethnic minorities of South Asian origin relative review focuses on the largest ethnic minority group: those of South Asian origin (with an ancestry from the to the indigenous population of the UK. Possible explanations for differential reporting of pain will then Indian Subcontinent: India, Pakistan or Bangladesh), which represent approximately half of all ethnic minority be assessed, including issues relating to social difficulties and acculturation, but with specific emphasis on cultural groups in the UK. interpretation of pain and pain thresholds (the subject of much research in the literature). Finally, the literature Consultation behaviour describing the experience of psychiatric distress, which is a common co-morbidity of the chronic pain experiA consistent finding in the literature is that adult Asians attend general practices more frequently compared with ence, in ethnic minority groups of South Asian origin will be appraised. the European population [5, 6 ]. A large-scale community survey comparing aspects of illness behaviour in Asian-born and British-born residents in London, UK, Defining ethnicity found that Asian men were more than twice as likely to consult their general practitioner (GP) in the previous The term ‘ethnic group’ is used in preference to ‘race’ in this review. Although it is evident that ‘race’ is used 2 weeks, irrespective of self-assessment of health or presence of illness/disability. Balarajan et al. [6 ] examconsiderably more frequently in the medical literature (a Medline search from 1985 to 1990 found that ‘race’ ined the levels of GP consultations among the different ethnic groups resident in Britain, and noted a 2-fold was mentioned in 5892 publications compared with 762 publications using the term ‘ethnicity’ or ‘ethnic group’ excess of consultations for Pakistani men aged 16–44 yr in comparison with European men, with higher rates also [1]), such terminology has been criticized as giving an inaccurate description of causation [2]. Race implies a evident for Pakistani women aged 16–44 yr relative to European women. A further study of a group general genetic basis when considering differential health status, suggesting that differences identified between individuals practice in London found a marked increase in the standardized consultation ratio for Asians [7]. Such are fixed or predisposed. Ethnicity is a cultural term, differences in health-seeking behaviour are not just evident in adults of the Asian population—children and Submitted 9 June 1999; revised version accepted 21 June 1999. young people from South Asian ethnic groups have also Correspondence to: D. Pope, Arthritis Research Campaign been found to be more likely to consult a GP compared Epidemiology Unit, School of Epidemiology and Health Sciences, The with European children and children of other ethnic University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK. groups [8]. However, it is not clear whether such findings