Chronic pain and use of painkillers, healthcare services and long-term impairment among Syrian refugees: a cross-sectional study

Abstract

Background: The global increase in forcibly displaced populations highlights the importance of understanding their health needs. Chronic pain is prevalent among refugees, poses significant personal and public health challenges, and complicates their integration into new home countries. Understanding refugees' pain post-migration and how it is being managed is crucial for ensuring adequate and timely interventions and fostering health equity. This paper explores the associations between pain levels and the use of painkillers, healthcare services, and long-term impairment among Syrian refugees with chronic pain, one year after their resettlement in Norway.

Methods: This cross-sectional study is based on survey data collected from 353 quota refugees in 2018-19, one year after resettlement in Norway. The primary outcomes were the use of painkillers, the use of healthcare services, and long-term impairment, according to reported chronic pain levels. Associations between these outcomes and chronic pain levels were studied using Poisson regression, adjusted by sociodemographic variables and trauma experience.

Results: Of the 353 adults included, 52% were women, and the median age was 36 years. A total of 5% reported very mild/mild, 10% moderate, and 12% strong/very strong chronic pain over the last four weeks. Significant associations were found between all chronic pain levels and use of non-prescription painkillers (adjusted relative risks (aRR) (95% CI)); mild (3.1 (2.0-4.7)), moderate (1.8 (1.1-2.8)), strong (1.7 (1.1-2.6)), and prescription painkillers; mild (4.6 (2.2-9.5)), moderate (5.6 (3.2-10.0)), strong (6.7 (3.9-11.3)), compared to those without chronic pain. Use of emergency rooms, specialist care, and hospitalization were significantly associated with strong chronic pain, with aRR (95% CI) of 2.0 (1.2-3.5), 3.9 (2.1-7.0) and 2.4 (1.3-4.4), respectively. Long-term impairment was strongly associated with chronic pain across all pain levels; mild (8.6 (5.6-13.49)), moderate (6.7 (4.3-10.5)) and strong (6.6 (4.3-10.4)).

Conclusion: Despite their young age, more than a quarter of the Syrian refugees in our study reported chronic pain one year after resettlement in Norway. High levels of pain were related to the use of medication, healthcare services, and long-term impairment. Understanding the dynamics of pain among refugees is crucial to ensure adequate and timely management.

Keywords: Chronic pain; Functional impairment; Pain levels; Painkillers; Refugees; Survey questionnaire; Syria; Trauma; Use of health care.

Fig. 1

Associations between levels of chronic pain and use of painkillers. Log-scaled coefficient plot illustrating the fully adjusted associations (Table A1a, Model 3) between pain levels last four weeks and use painkillers last four weeks shown by aRR (dot) and 95% CI (bar). Note that a value of 1 indicates the reference group without pain

Fig. 2

Associations between levels of chronic pain and use of health care services. Log-scaled coefficient plot illustrating the fully adjusted associations (Table A1b, Model 3) between pain levels last four weeks and use of general practitioner (GP), emergency room services (ER), specialist health care and hospitalization during the last 12 months shown by aRR (dot) and 95% CI (bar). Note that a value of 1 indicates the reference group without pain

Fig. 3

Associations between levels of chronic pain and impairment. Log-scaled coefficient plot illustrating the fully adjusted associations (Table A1c, Model 3) between pain levels last four weeks and long-term impairment (lasting > 12 months) and type of impairment, shown by aRR (dot) and 95% CI (bar). Note that a value of 1 indicates the reference group without pain