Managing Chronic Pain in Native Americans, Alaskan Natives, and First Nations: a scoping review and expert consensus

Evidence shows that Native American (NA) and Alaskan Native (AN) patients disproportionately suffer from increased chronic pain in relation to other patient populations.1 The aim of this study is to elucidate the reasons why these discrepancies exists, see what research has been done to combat these disparities, and compile insight and parallels from research done in institutional academic circles and traditional NA healer communities. There are ~ 2.9 million people who report exclusive NA/AN ancestry and the 1.6 million who report partial NA/AN ancestry, organized into 564 federally recognized tribes.2 Indian Health Services provides care only to about 1.5 million NA/ANs. Further, the IHS has been chronically underfunded and is seldom equipped to provide specialty services, such as care for chronic pain.3,4 Due to a complex amalgamation of socioeconomic and historic factors, NA/ANs disproportionately suffer from increased PTSD, opioid use disorder and chronic pain.3,5 Treatment of NA/ANs can be challenging due to a number of factors. NA/ANs commonly turn to treatments grouped under the rubric of “traditional” or “Native healing”. Which typically focus on identifying and responding to the underlying causes of disease (often attributed to spiritual factors) rather than on treating acute conditions.2 NA/ANs patients are concerned about opioid addiction and the disbelief in the ability of medications to alleviate pain. Studies have also found that clinicians identified their own concerns about inducing addiction (or re-addiction) as a barrier to treating pain in NA/ANs patients.2 Blended models of care are common in NA communities, In one survey of 869 urban AI/AN patients in primary care, 70% used traditional health practices.2 The goals of this project are to compile a list of interventions that have been implemented in the clinical and non-clinical setting (Tribal Healers) that have been shown to decrease pain in NA and HA populations. Based on these reviewed expert opinions, this paper will outline possible novel interventions that will be useful in the clinical setting. Many current reviews offer important insights regarding this topic. However, oftentimes, they do not fully capture the wide range of Indigenous populations across North America. Our study aims at addressing this gap by adopting a wider lens. We seek to bring together both tribal and institutional data, as well as interventions proposed by experts. Based on our research, there are no reviews specially looking at implemented interventions and their effect on these populations, making ours the first. In doing so, we plan on better understanding which approaches are most effective, the patient population that responds most completely, and what circumstances allow this to take place. Greensky, C., Stapleton, M. A., Walsh, K., Gibbs, L., Abrahamson, J., Finnie, D. M., Hathaway, J. C., Vickers-Douglas, K. S., Cronin, J. B., Townsend, C. O., & Hooten, W. M. (2014). A qualitative study of traditional healing practices among American Indians with chronic pain. Pain medicine (Malden, Mass.), 15(10), 1795–1802. Jimenez N, Garroutte E, Kundu A, Morales L, Buchwald D. A review of the experience, epidemiology, and management of pain among American Indian, Alaska Native, and Aboriginal Canadian peoples. J Pain. 2011 May;12(5):511-22. doi: 10.1016/j.jpain.2010.12.002. Epub 2011 Feb 18. PMID: 21330217; PMCID: PMC3090505. Bassett, D., Buchwald, D., & Manson, S. (2014). Posttraumatic stress disorder and symptoms among American Indians and Alaska Natives: a review of the literature. Social psychiatry and psychiatric epidemiology, 49(3), 417–433. https://doi.org/10.1007/s00127-013-0759-y Meints, S. M., Cortes, A., Morais, C. A., & Edwards, R. R. (2019). Racial and ethnic differences in the experience and treatment of noncancer pain. Pain management, 9(3), 317–334. https://doi.org/10.2217/pmt-2018-0030 Johnson, F., Jr, RedCloud, A., Mootz, J., Hallgren, K. A., Elliott, K., Alexander, C., Aanji'bide Community Action Board, & Greenfield, B. L. (2023). Community member perspectives on adapting the cascade of care for opioid use disorder for a tribal nation in the United States. Addiction (Abingdon, England), 118(8), 1540–1548. https://doi.org/10.1111/add.16184