New research has found that instead of being offered referrals to specialists, Māori adults who experience chronic pain are being prescribed painkillers at the expense of best practice treatments.
The research was done by the Māori community health provider Tu Kotahi Māori Asthma and Research Trust and the University of Otago, Wellington. It was based on kanohi ki te kanohi face-to-face focus groups with 13 kaiāwhina community health workers, who provide a link between the health sector and Māori communities.
Doctors failing to provide holistic explanations
The kaiāwhina reported that treatment of chronic pain in Māori at a primary health care level was based almost entirely on prescribing pain medication, with doctors failing to provide holistic explanations about the causes of their pain.
One kaiāwhina said, “They do not even understand their own pain, and where it’s coming from; they are just … dished out pills constantly to mask their pain.”
Research fellow at the Centre for Health, Dr Hemakumar Devan, worked on the study with senior research fellows in the Department of Medicine, Dr Tristram Ingham and Bernadette Jones, as well as manager of the Tu Kotahi Māori Asthma and Research Trust, Cheryl Davies.
Davies, of Ngāti Raukawa and Ngāti Mutunga ki te Wharekauri, said very few patients were being offered the option of being referred on to a specialist pain clinic by their GP.
“The referrals were not coming through from the GP clinics and then at the other end, there was quite a large waiting list to even be able to access the pain clinic if you were referred on. There were barriers all the way through the system.”
Māori adults are 1.4 times more likely than non-Māori adults to report experiencing chronic pain, a 2020 New Zealand Health Survey found.
Rongoā and mirimiri
The kaiāwhina told focus group facilitators that some whānau used rongoā traditional Māori methods of healing to manage their pain, but did not usually talk to their doctors about this.
One kaiāwhina said, “Often, they’ll say, ‘I don’t really want to tell the doctor; I’ll just live with it … the doctor will just give more panadol or tramadol or more prednisone’ and they don’t want any more medication. So, they … make their own remedies. (They) might use some rongoā; that’s quite useful for bringing inflammation down in your body, and they kind of ease the pain that way.”
The research also found traditional healing methods, such as mirimiri (massage), were valued by some whānau for managing their pain because they not only improved tinana physical health but also wairua spiritual and hinengaro psychological wellbeing.
Kōkiri Marae management clinic
Davies says the project has led to a pain management clinic being run at Kōkiri Marae. A whānau-focused pain management programme was also recently held in Wainuiōmata for the first time.
“I think we are the first to hold a community pain management clinic in this way, so this study has been more than just doing the research. We have been able to implement some interventions which has had a huge impact for our community.”
Devan suggests introducing community-based solutions to achieve equitable outcomes, which could include providing training for kaiāwhina to provide chronic pain assessment and management in the community.
“Kaiāwhina-led pain education services could provide whānau with educational resources and facilitate communication with their primary care providers for referrals to specialist services if required,” says Devan.