LGBTQI+ and Pain

Dr Chow Chow

Dr Chow Chow

Key points

  1. LGBTQI+ population are more likely to experience discrimination, abuse, exclusion and prejudice than the broader population.

  2. Interaction with healthcare providers play a vital role for the health-related outcomes among the LGBTQ population.

  3. Personalised comprehensive biopsychosocial management plans are recommended for LGBTQ population living with pain.

Disparities in LGBTQI+ health care is not new. One of the key factors are the lack of understanding of the population needs.(1) LGBTQI+ population report high levels of chronic pain, (2) higher degrees of functional disability, (3) and increased reports of widespread body pain compared to heterosexuals. (4)

Chronic Pain Contributors 

Discriminated LGBTQI+ youth have higher levels of depression and suicidality. (5) The relationship between depression and chronic pain is multifactorial. Nevertheless, the shared vulnerability and the neurobiology changes is highly suggestive for the development of persistent pain. 

LGBTQI+ population have greater incidence of internalising symptoms, such as anxiety and depression, possibly due to discrimination, peer victimisation and societal disapproval/rejection. They are at higher risk of susceptible to bullying and harassment, which further contributing to the psychological trauma that have serious implications on their pain management. (6) 

Other health-related issues include body image issues, substance use disorder, effects of hormone use in transgender population, the use of modern antiretroviral medications for both prophylaxis and treatments. Each of these issues need detailed discussion with the health professionals to explore the best methods to manage the general physical, emotional and social wellbeing of the person. 

Interaction with Healthcare Providers 

The availability and accessibility of treatments for LGBTQI+ population has improved throughout the years. However, LGBTQI+ population often encounter discrimination and mistreatment by the healthcare providers. (7) This includes refusal to provide services, verbally abusive, dismissive or unwanted physical behaviour. As a result, some LGBTQI+ population may avoid or delay care, which may impact their overall health care outcomes. 

For the LGBTQI+ living in rural Australian community, the potential use of online technologies might overcome the geographical accessibility barriers. Internet-based medicine might be effective in delivering people-centred services to meet the unique needs of this community. (8) 

Dr Chow Chow embrace diversity, encourage inclusion and promote equitable outcomes for people of different race, colour, religion, gender, gender expression, sexual orientation, age, national origin, disability, marital status and status of health funds. If you or anyone you know is in crisis, immediate help is available. There is hope. Please contact Lifeline Crisis Support Service on 13 11 44. If life Is in danger, call 000.

Serious note asides, Dr Chow Chow wishes you a happy Sydney Mardi Gras 2021. Please do not forget to test often, treat early and stay safe.
#EndingHIV #MardiGras2021 #WeRiseFor

Practical points:

  1. Healthcare providers should provide care that tailored to the vulnerable LGBTQ population, without being influenced by their beliefs or prejudice.

  2. Do not make assumptions. Careful attention to bedside manners is always important. If the provider is unsure about terminology, or a definition, it is always better to ask.

  3. Antiretroviral drugs are normally safe with most analgesia. If your patient is on Cannabidiol and emtricitabine, it may be beneficial to check the liver function test as both drugs are known to induce hepatotoxicity. If your patient is on Tenofovir and NSAIDs, kidney function should be monitored as both agents increase the risk of renal impairment.

References

  1. The Joint Commission. Advancing effective communication, cultural competence and patient and family centered care for the lesbian, gay, bisexual and transgender (LGBT) community: a field guide. 2014. Oakbrook Terrace, Illinois: The Joint Commission.

  2. Safren S, Heimberg R. Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents. J Consult Clin Psychol. 1999;67:859–866.

  3. Case P, Austin SB, Hunter DJ, et al. Sexual orientation, health risk factors, and physical functioning in the Nurses’ Health Study II. J Womens Health. 2004;13:1033–1047.

  4. Cochran S, Mays V. Physical health complaints among lesbians, gay men, and bisexual and homosexually experienced heterosexual individuals: results from the California quality of life survey. J Public Health. 2007;97:2048–2055.

  5. Addressing the health needs of sex and gender minorities in New Mexico. 2018. https://nmhealth.org/publication/view/report/4514/.

  6. Katz-Wise SL, Everett B, Scherer EA, Gooding H, Milliren CE, Austin SB. Factors associated with sexual orientation and gender disparities in chronic pain among U.S. adolescents and young adults. Prev Med Rep. 2015;2:765–772.

  7. Mirza SA, Rooney C. Discrimination prevents LGBTQ people from accessing health care. 2018. https://www.americanprogress.org/issues/lgbt/news/2018/01/18/445130/discrimination-prevents-lgbtq-people-accessing-health-care.

  8. Bowman S, Nic Giolla Easpaig B, Fox R. Virtually caring: a qualitative study of internet-based mental health services for LGBT young adults in rural Australia. Rural and Remote Health. 2020 Jan;20(1):5448.

Here’s An Easy Way to Show You Care

Thank you for your kind referral, please also fax us a copy of patient’s health summary with their current medication and medical history at (02) 8088 7877


PO Box 415 MOSMAN NSW 2088
Phone 02 8866 1393
Fax 02 8088 7877
info@drchowchow.com
Healthlink: tzechowc

DR CHOW CHOW

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