Research shows that the Aboriginal and Torres Strait Islander (ATSI) population has a higher prevalence of chronic diseases, than non-indigenous Australians.
Chronic disease generally refers to a prolonged disease over time that doesn’t resolve spontaneously; is rarely cured completely; and can be associated with functional impairment or disability (2).
The implications of chronic diseases on the Aboriginal and Torres Strait community are two-fold:
- They create wellbeing issues for the individual; and,
- Chronic health conditions are inter-generational.
Some common chronic diseases experienced by the ATSI population include musculoskeletal disorders and chronic pain.
The most common musculoskeletal disorders are arthritis and fibromyalgia.
Arthritis comes in the form of either osteoarthritis or rheumatoid arthritis. Osteoarthritis is the most common, being a joint disorder it can affect the knees, hands, feet, and neck; while the second most common form of arthritis is rheumatoid arthritis, an inflammatory autoimmune disease (16). Symptoms can progress gradually, resulting in very painful and disabling chronic muscle and joint pain, and have a negative impact on the quality of life of patients and their families.
Studies show that osteoarthritis may have a genetic component, but is largely due to repeated trauma or infection due to heavy physical work to the joint. Risk factors include obesity, joint injury, and repetitive use of the joints (3).
Rheumatoid arthritis is characterised by inflamed tissue in the joints, causing swelling, pain, and stiffness. This may lead to functional limitations as it occurs mainly in the hands, feet, and wrists. Diagnosis is through a blood test showing auto-antibodies which are believed to cause the main damage, although not all sufferers have this result. A combination of X-rays, laboratory tests and clinical assessment is currently available, although early treatment is paramount as irreversible joint damage can occur (10). Moreover, infection has been shown to start the disease in susceptible people (16).
Fibromyalgia is largely unknown and difficult to diagnose due to no current objective testing and no physical abnormalities found, but is associated with abnormalities in the central nervous system processing of painful stimuli (25).
While fibromyalgia patients have normal detection thresholds for electrical, pressure, or thermal stimuli, their pain thresholds are abnormally low for these stimuli. It is unclear how the changes in pain perception occurs, but is commonly explained by the neuromatrix theory (19).
The neuromatrix theory proposes that pain is a multidimensional experience from patterns of nerve impulses generated by the neural network in the brain. The theory asserts that the patterns may be triggered by sensory inputs, or generated independently. The output patterns of the body-self neuromatrix activate perceptual, homeostatic, and behavioural programs after injury, pathology, or chronic stress. As such, pain is produced by the distributed neural network in the brain rather than directly by sensory input evoked by injury, inflammation, or other pathology (19).
Studies show approximately 50% of patients with fibromyalgia state their pain started after a traumatic event, viral infection, emotional stress, and autoimmune disorders (6).
Additionally, fibromyalgia has been found to occur in cases of past childhood abuse or neglect, drug abuse, or eating disorders (12). Interestingly, no studies were found showing the prevalence or incidence of fibromyalgia among Aboriginal and Torres Strait Islander people. However, given the association of the ATSI population with traumatic events and intergenerational trauma, including childhood abuse (1), it might be expected to be more common than in the non-Indigenous Australian population.
Pain is generally a result of tissue damage in a simple pathophysiological process.
However, evidence from clinical and laboratory-based research shows that pain can also present as a more complex issue with pain existing without tissue damage, and tissue damage evident without pain (24).
Due to the complexity of pain, the assessment process and identification of chronic pain needs to be multidimensional (24). Such information required includes pain history, pain intensity, management strategies employed, and treatment approaches (23).
Additional self reported information regarding the client’s beliefs about their pain, the impact pain has on their wellbeing, and the context surrounding the onset of the pain will add to the process. Symptoms often associated with pain include depression (5), anxiety (15), trauma and torture (4), acceptance (20), self-efficacy (9), pain beliefs (22), catastrophizing (8), sleep (17), prescribed medication and recreational drugs (11), and social support (20).
If you are experiencing issues with musculoskeletal disorders and have symptoms of sadness, distress or anxiety, a psychologist can assist with your health and wellbeing.
Author: Cassandra Gist, BPsych (Hons), MPsych, MAPS.
Brisbane Psychologist Cassandra Gist has a Masters in Health Psychology, and is able to treat clients aged from two years old right through to adulthood. She is experienced in working with Aboriginal and Torres Strait Islander communities, as well as children and families affected by Autism Spectrum Disorder.
To make an appointment with Brisbane Psychologist Cassandra Gist, try Online Booking – Loganholme or Online Booking – Mt Gravatt. Alternatively, you can call M1 Psychology (Loganholme) on (07) 3067 9129, or Vision Psychology (Mt Gravatt) on (07) 3088 5422.
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