Introduction

Health inequality is an issue influenced by many factors including geography, language and communication barriers, patient preferences, health literacy, waiting times, perceived discrimination, and physician bias. Patient ethnicity and language barrier is a theme that can often underlie many of these factors.

34% of adults in the UK (Adult Chronic Pain Health Survey, 2017) suffer from some degree of chronic pain. This burden has the potential of similar prevalence in patient populations suitable for neuromodulation therapies although this has not been reported before. This is the first quantification of outcomes in patients with language barrier highlighting key issues around SCS efficacy in this population.

Materials / Methods

After local approval, data from 494 patients (May 2021- June 202) in a large tertiary inner-city hospital was reviewed. From this pool 44 patients were identified (9%) whose native language was not English with 31 (70%) being suitable for SCS, demonstrating demand for such services amongst ethnic minority. Data from 25 patients whose first language was not English who underwent SCS was analysed.

Results

Of 25 SCS patients, seven (28%) were eventually explanted which is higher than our average explant rate (4%). In the non-explant group (n=18) mean NRS decreased from 7.88 at baseline to 3.75 at 12 months (n=8) with average EQ5D scores increasing from 0.211 at baseline (n=18) to 0.76 at 12 months (n=8). The data collection is still ongoing, and the final results will be presented at eINS.

Discussion

The 2021 UK census showed that 7.1% of the population were proficient in English but did not use it as their main language, 1.5% of the population could not speak English well and a further 0.3% of the population could not speak English at all. There are certain areas of the UK where the percentage of people unable to speak English were even higher than this national figure (Birmingham, Manchester, City of London – 5.2%, 3.7% and 1.0% respectively). The significant higher explant rate reported could indicate the lack of education and cultural barriers about therapy. Simultaneously the improved EQ5DL and NRS validates the need of therapy to this vulnerable group.

Conclusions

There is a growing demand for healthcare to be delivered to patients who are unable to speak native language. This is first ever study highlighting the outcomes for SCS in patients with language barrier in ethnic minority group.

References

1. Office for National Statistics (ONS), released 29 November 2022, ONS website, statistical bulletin, Language, England and Wales: Census 2021

2. Chronic pain in adults 2017 Health Survey for England, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/940858/Chronic_Pain_Report.pdf

Learning Objectives

1. There is a growing demand for healthcare to be delivered to patients who are unable to speak native language.

2. This is first ever study highlighting the outcomes for SCS in patients with language barrier in ethnic minority group.

3. The significant higher explant rate reported could indicate the lack of education and cultural barriers about therapy.