Predictors of Medical and Vocational Rehabilitation Treatment Compliance among African Americans with Chronic Pain Conditions: An Exploratory Study

By Washington-Walker, Janique; Moore, Corey L. et al. | Journal of Applied Rehabilitation Counseling, Winter 2017 | Go to article overview

Predictors of Medical and Vocational Rehabilitation Treatment Compliance among African Americans with Chronic Pain Conditions: An Exploratory Study


Washington-Walker, Janique, Moore, Corey L., Whittaker, Tyra Turner, Wagner, Miriam L., Journal of Applied Rehabilitation Counseling


Chronic Pain is a medical condition that has gained increased exposure over the past decade (Freburger, Holmes, & Agans, 2009). According to the Institute of Medicine of the National Academies (2011), 100 million Americans are impacted by chronic pain. Chronic pain conditions affect multiple areas of the body, most prevalently manifested as back pain (27%), severe headaches or migraines (15%), neck pain (15% ), and facial aches or pain (4% ) (Centers for Disease Control, 2016). More specific to the context state where target group members reside (i.e., North Carolina), state level cross-sectional data (i.e., Freburger et al., 2009)document a 6% rise in the prevalence of chronic pain conditions such as lower back pain from 1992 (3.9%, 95% (CI), 3.4%4.4%) to 2006 (10.2%, 95% (CI), 9.3%-11.0%) among adults age 21 and older; 4,437 households in 1992 and 5,537 households in 2006 (Freburger et al., 2009).

Chronic pain represents a debilitating condition that can reduce an individuals' capacity to participate optimally in activities of daily community living (Ilgen et al., 2010). The execution of life roles can become taxing, and often the person's quality of life is diminished (Van Hal, Meershoek, Nijhuis, & Hortsman, 2013). When chronic pain conditions are an impediment to employment and vocational functioning is compromised, the individual will require services from the state vocational rehabilitation (VR) program (D'Amico, Leonardi, Grazz, Curone, & Raggi, 2015). VR service access and provision may be necessary to assist such individuals in identifying work accommodations to regain or retain employment (Falvo, 2014).

Traditionally, chronic pain patients were treated from a separatist framework in which there was little collaboration between VR and medical providers. However, a growing body of contemporary literature support interdisciplinary treatment models where individuals experiencing a chronic pain condition receive services from a multidisciplinary group of providers (Gagnon, Stanos, van der Ende, Rader, Harden, 2013; Hamer, Ghandi, Wong & Mahomed, 2013; Myher & Augustad, 2013). Pain can be managed successfully with proper medical treatment (Kipping, Maier, Bussemas, & Schwarzer, 2014), and consequently, individuals suffering from such conditions can better function in their work and community contexts. However, client compliance with multidisciplinary team recommendations is necessary to achieve positive medical and vocational outcomes (Gagnon et al., 2013; Hamer et al., 2013; Myher & Augustad, 2013). When pain is managed successfully, individuals experience a reduction in pain. Consequently, they often experience improved daily functioning, report stable moods, have healthy social and community-based interactions, and report improvements in their overall quality of life (Bishop, Chapin & Miller, 2008; Debatey, Halimi, Quesada, Baudrant, Allenet, & Benhamou, 2008). With successful medical treatment, many VR consumers living with chronic pain conditions may be able to engage in work related and community living activities (Frain, Bishop, Tschopp, Ferrin, & Frain, 2008; Morgan, 2010).

While many individuals living with disabilities experience service access and employment equity challenges (Lukyanova, Balcazar, Oberoi, & Suarez-Balcazar, 2014), such restrictions can be further complicated due to secondary racial or ethnic minority status (Lyons, 2011). For example, African Americans with chronic pain conditions may be exposed to additional quality of life challenges (Lyons, 2011). Members of this target racial population tend to experience a greater incidence of health disparities compared to other racial/ethnic groups, particularly those who fall within lower social economic statuses (Walls & Dowler, 2015). Health-related disparities such as affordability of medical treatment, access to health-related resources, and transportation limitations can negatively impact pain management and serve as barriers to successful VR treatment (Davis et al. …

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