Low health literacy was a significant predictor of pain catastrophizing and pain self-efficacy, according to a cross-sectional study of 300 indigent patients with chronic pain at five low-income clinics in rural Alabama
- experiencing want or need; impoverished,
- so poor as to lack even necessities; very needy
- lacking the necessities of life because of poverty; needy; poor;
This study was done on patients who are living extremely difficult lives with constant hardship and little medical care, so the results cannot be generalized to any other group.
“Robust and reliable data show time and again that those with low income and/or lower educational attainment, racial minorities and rural patients suffer a greater burden of chronic pain and other chronic physical health conditions,” said principal investigator Beverly Elaine Thorn, PhD, professor of psychology at the University of Alabama in Tuscaloosa.
“It is logical to expect that patients who are not able to appropriately understand the information about their condition, as well as how to manage it properly, would experience heightened fear, anxiety and lowered perception of their ability to manage their chronic pain,” added lead author Shweta Kapoor, MD, PhD
The problem here is poverty, not pain!
“A whopping 36% of U.S. adults have below basic to basic health literacy,” Dr. Thorn said.
Furthermore, among U.S. adults who are enrolled in Medicare, 33.9% of English-speaking and 53.9% of Spanish-speaking respondents had inadequate or marginal health literacy. “Thus, the inability to understand medical information, provider instructions and pharmacy directions is a substantial issue,” she said.
More Than Just Education Level
these individuals are less likely to have received important, relevant and understandable information regarding pain and how the brain processes pain,” Dr. Thorn said in a follow-up interview with Pain Medicine News. “These patients are also rarely given coping-skills training to help manage chronic pain conditions.”
Again, this is a result of poverty, which leads to fewer educational opportunities (due to financial restraints), living in poorly-served areas, and thus to inferior health care.
The paragraph below states the correlations were “medium size”, yet the headline calls it a “Strong correlation”. (Media bias, inflated headlines, biased coverage)
The correlations between both catastrophizing and reading level and catastrophizing and health literacy were of medium size. The relationship between self-efficacy and health literacy also was of moderate size, but with reading level the connection was small.
Catastrophizing comes from their life situation much more than their pain.
No one can seriously expect indigent people suffering extreme poverty to have positive outlooks and have time to educate themselves. Blaming their pain on their “catastrophizing” shows how out of touch these researchers are.
it is important to examine the health literacy of patients as opposed to just relying on their education level to estimate their ability to understand the medical information being provided.”
Dr. Kapoor pointed out that a substantial proportion of chronic illnesses that are not managed well are often attributed to patient adherence issues. “However, our finding may help reconceptualize this problem and understand how we can bolster health literacy to manage a part of the chronic illness burden,” she said.
When medical problems are blamed on “patient adherence issues”, doctors absolve themselves by blaming the patients.
“Emerging data is showing a strong association between disability and social dysfunction. In other words, there is more than the physical ailment factor that determines patients’ perception of themselves and their level of disability. Health education and literacy, as well as social support and satisfaction, play an important role.”
#It never occurs to them that disability usually CAUSES social dysfunction because people can no longer easily particiapte in social life. Ignoring this obvious and well-known fact shows to what lengths these people will go to demonize patients.
Dr. Mchaourab believes a cultural change is needed in health care.
“Patients are always expecting to get a pill, a procedure, even surgery, as an answer for what they have,” he said.
In our society, this is exactly the view popularized by the media, and especially in direct to consumer drug advertising.
“If a physician recommends rehabilitation or lifestyle changes, that physician is not always well perceived, as studies have shown.”
This is because a physician will propose lifestyle changes more appropriate for themselves and other well-off people. Most have no clue about the restraints poverty puts on people’s lives.
People living in poverty have no time for extended treatments involving multiple regular visits, especially because such absences can get them fired from their low-level jobs.
For chronic illness management, Dr. Thorn proposes a collaborative approach: patients partnering with health care providers in disease management.
Patients with chronic illnesses need to be taught about their illness in a way they can understand it, and they need to be given self-management skills in a way they can implement,” she said.
However, both objectives need to be achieved within the context of a provider attitude that conveys: “I believe your pain is real, and there are skills we can teach you to help manage your own pain,” Dr. Thorn said.
The stronger correlation is between pay level and health literacy. Higher pay means a better job, better benefits, sick leave, and flextime which allows for various doctor’s appointments. Poor paying jobs, on the other hand, have no benefits, no sick leave,no flex time, so any time off work is unpaid and risks a firing.