Musculoskeletal pain (such as low back pain, osteoarthritis, neck, knee and shoulder pain) is the number one cause of disability in Australia and affects 28% of Australians. It is one of nine national priorities in health.
Some 20% of Aboriginal Australians suffer long term musculoskeletal pain and to date it has received little attention or recognition.
Aboriginal Australians face many pressing health issues including a substantial gap in life expectancy. Musculoskeletal pain does not commonly contribute to reduced life expectancy, unlike other conditions such as heart disease, diabetes, lung disease and cancer.
It makes sense to direct resources toward conditions that reduce life. But musculoskeletal pain causes substantial disability and suffering and is often present alongside other long term health conditions that cause death. For example 41% of individuals with heart disease and diabetes also report arthritis, and 29% of people with diabetes report back pain.
Musculoskeletal pain may prevent people from managing their other health issues. For example a person who has heart disease may not be able to exercise (which is a cornerstone of management) if they have a painful back or a stiff, painful osteoarthritic knee.
Musculoskeletal pain in Aboriginal people is an area that hasn’t received enough attention. This could be based on a couple of enduring myths.
Myth 1: musculoskeletal pain has less of an impact on Aboriginal people
Something we’ve often heard in clinical practice is that Aboriginal patients put up with pain, that they are tough, and inherently stoic. This has also been reported in research. For example a 1958 study stated Aboriginal people possess a “stoic indifference to pain, often commented on and displayed”.
Another study of low back pain in a remote central Australian community concluded that, despite almost half of community members reporting back pain when asked, few community members complained about it, ostensibly because low back pain was not considered to be a health issue.
However these findings differ markedly to what we have found. In one study we talked to Aboriginal people about their low back pain. Aboriginal men and women talked about the impact of their pain on employment and sport (particularly men), family, daily functions, their emotions and cultural participation.
Cultural participation included the inability to “go bush” to connect to country and hunt, attend funerals, or cultural meetings. Another study found 8% of residents in a Queensland semi-rural community were limited in their activities due to musculoskeletal pain.
Aboriginal people are 1.5 times more likely to have osteoarthritis than non-Aboriginal people, and have an overall higher burden of disease. This means instead of less impact, musculoskeletal pain is likely to be more complex and be of greater impact.