Chronic musculoskeletal pain. Discordant management conversations: the influencing factor of polarized politics

Background: The chronic musculoskeletal pain (CMP) epidemic occurs concurrently during historical mass population movements and significant income inequities. Epidemiological studies indicate CMP may occur disproportionately in marginalized populations. Nationalistic rhetoric has arisen, in part, due to perceived concerns over access to healthcare. Political policies directly and indirectly impact healthcare. Objectives: To explore 1) how potential historical, societal, and political factors may contribute to the clinical conversation of pain; 2) the impact ineffective clinical conversations may have on the CMP experience. Methods: Literature Review. Major Findings: CMP is an invisible disease decoupled from normal tissue healing. The clinical conversation is increasingly recognized to impact treatment outcomes. The clinician and the patient bring differing histories, values, and interpretations to clinic visits. Systemic healthcare racism, implicit biases, incongruent provider/patient assessment of pain, and provider stigmatization contribute to olgioanalgesia. As healthcare professional groups become more politically active, providers bring that political experience into the clinic. Marginalized populations, at risk for greater stress, discrimination, and fear bring their own intensified political perceptions into the clinic. We suggest that poor management and discordant clinical conversation may be adversely influenced by the current political climate. Conclusion: Identifying contributing factors to ineffective clinical conversations is important to improve CMP outcomes and to minimize inequities in CMP management. We hope to identify populations that may be more vulnerable to political biases, understand factors in the clinical conversation that are important to patients, and to build opportunities to educate providers and patients on these forces impacting the clinical conversation.