Experiences and impact of chronic pain in South Africans living in a rural area: a qualitative study

ABSTRACT Objectives Previous work in South Africans living with HIV and chronic pain has raised questions regarding maintained levels of physical activity whilst in pain, patterns of pain disclosure and recruitment of social support. Recent data suggest that pain in people living with HIV may be more due to issues of poverty rather than HIV. We explored how South Africans with chronic pain living in a rural area: i) understand and experience chronic pain, ii) how chronic pain affects activity levels and iii) the relationship between pain disclosure and social support. Design We conducted a qualitative study using in-depth interviews. Transcripts were analysed using thematic data analysis. Setting The Ndlovu Care Group Research Centre in the rural Elandsdoorn, Dennilton area in Limpopo province, South Africa. Participants Thirty-four individuals (19 women, 15 men) with mean age 37 years (SD 8) living with chronic pain, half of whom were living with HIV, and half without. Results Perceived causes of pain included illness or injury, ‘thinking too much’ and non-Western perspectives. Three patterns of activity in response to chronic pain emerged: perseverance, reduced activity, and complete inactivity. Reasons for perseverance included fear of losing income, perceived social stigma, or no social support. Patterns of pain disclosure included full, selective (telling some people but not others depending on their perceived trustworthiness), partial (sharing pain presence but not how severe it was), and non-disclosure. Disclosing pain was common in women and was used to recruit practical support. Men rarely disclosed to recruit support, and if they did, would recruit for financial support. Disclosing pain was also a strategy to avoid the social stigma of being labelled ‘lazy’. Patterns of activity, disclosure, and type of support recruited did not differ between those with and without HIV. Conclusions Our findings suggest that activity levels, disclosure and recruitment of support in South Africans living with chronic pain are influenced by low income, social stigma, and gender, rather than HIV.