title: Exploring the experience of chronic pain among female Survival Sex Workers: a qualitative study.
abstract: BACKGROUND
  The prevalence of self-identified chronic pain in Canadian adults is approximately one in five people. Marginalization and addictions have been shown to complicate chronic pain in vulnerable populations. This study aimed to understand the experience of chronic pain among female Survival Sex Workers in Vancouver's downtown eastside (DTES).
  
  
  METHODS
  This study used an exploratory qualitative analysis with in-depth, semi-structured interviews. Members of PACE Society who self-identified as a current or former Survival Sex Worker and who had a chronic pain experience known to PACE support workers were invited to participate. Interviews were conducted, audio recorded and transcribed. The investigators met to read the transcripts and discuss emerging themes. The process continued until no new themes were observed.
  
  
  RESULTS
  Participants ranged in age from 42 to 56 years old and all self- identified as females and Survival Sex Workers. Eleven of thirteen interviews were analyzed for themes. Drug use for pain management, both prescribed and illicit, was the most important theme. Poverty, the need to continue working and the lack of stable housing were barriers to adequately addressing the source of chronic pain. Participants felt judged for living in the downtown eastside, being a drug user and/or being Aboriginal and only two participants had been referred to a pain specialist. All participants were involved in support networks made up of other Sex Workers and all spoke of a sense of community and survival.
  
  
  CONCLUSIONS
  Our study emphasizes the complex nature of chronic pain and addictions among a uniquely marginalized population. The study is unique in that it contributes the perspectives of a traditionally "hard-to-reach" population and demonstrates that Sex Workers should not only participate in but should lead development and implementation of research and programs for managing chronic pain in the setting of addiction.
authors.affiliation: PACE Society, British Columbia, Vancouver, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Allen
authors.affiliation: PACE Society, British Columbia, Vancouver, Canada.
authors.forename: Alka
authors.initials: A
authors.lastname: Murphy
authors.affiliation: PACE Society, British Columbia, Vancouver, Canada.
authors.forename: Sheri
authors.initials: S
authors.lastname: Kiselbach
authors.affiliation: Department of Family Practice, University of British Columbia, Vancouver, Canada. vandenberg.stephanie@gmail.com.
authors.forename: Stephanie
authors.initials: S
authors.lastname: VandenBerg
authors.affiliation: Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. ellenwiebe@gmail.com.
authors.forename: Ellen
authors.initials: E
authors.lastname: Wiebe
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D059350:Chronic Pain / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011203:Poverty; D015995:Prevalence; D036301:Qualitative Research; D060386:Sex Workers / Q000706:statistics & numerical data*; D015996:Survival Rate / Q000639:trends; D035862:Vulnerable Populations / Q000706:statistics & numerical data*