Interactions of a history of migration with the course of pain disorder.

OBJECTIVE Previous studies indicate that sociocultural factors affect the course of pain disorder. We investigated the role of nationality as an indicator of cultural factors, and of the degree of inclusion (DI) in Swiss society as an indicator of the migration process on the course of pain disorder. METHOD In a semiprospective case-control study, outcome was assessed after a 2-year follow-up in 57 patients treated for pain disorder by phone interview with the patients. One Swiss patient was matched with two Spanish or Italian patients living in Switzerland. Patients' appraisal of course of illness (PACI) and of current general health (PACGH) were assessed as the sum score of their ratings of general well-being, handicap in everyday life, work ability, mood and pain. Family physicians were also asked to rate patient's course of illness. DI in Swiss society was assessed according to type of work permit, age at immigration and fluency in the language of the receiving country. RESULTS Swiss patients evaluated their PACI [H(1,56) = 4.30; P = .0038] and PACGH [H(1,56) = 9.04; P = .003)] more favourably than patients from Italy and Spain. This difference was confirmed by the family physician's evaluation of the course of illness. A similar difference in outcome was found in favour of foreign patients with a higher DI. CONCLUSION These results indicate that, in addition to sociocultural factors, the DI affects the outcome of pain disorder in patients with a history of migration.