title: "I'm healthy, I don't have pain"- health screening participation and its association with chronic pain in a low socioeconomic status Singaporean population.
abstract: BACKGROUND
  We sought to determine the association between chronic pain and participating in routine health screening in a low socioeconomic-status (SES) rental-flat community in Singapore. In Singapore, ≥ 85% own homes; public rental flats are reserved for those with low-income.
  
  
  METHODS
  Chronic pain was defined as pain ≥ 3 months. From 2009-2014, residents aged 40-60 years in five public rental-flat enclaves were surveyed for chronic pain; participation in health screening was also measured. We compared them to residents staying in adjacent owner-occupied public housing. We also conducted a qualitative study to better understand the relationship between chronic pain and health screening participation amongst residents in these low-SES enclaves.
  
  
  RESULTS
  In the rental-flat population, chronic pain was associated with higher participation in screening for diabetes (aOR = 2.11, CI = 1.36-3.27,P< 0.001), dyslipidemia (aOR = 2.06, CI = 1.25-3.39,P= 0.005), colorectal cancer (aOR = 2.28, CI = 1.18-4.40,P= 0.014), cervical cancer (aOR = 2.65, CI = 1.34-5.23,P= 0.005) and breast cancer (aOR = 3.52, CI = 1.94-6.41,P< 0.001); this association was not present in the owner-occupied population. Three main themes emerged from our qualitative analysis of the link between chronic pain and screening participation: pain as an association of "major illness"; screening as a search for answers to pain; and labelling pain as an end in itself.
  
  
  CONCLUSIONS
  Chronic pain was associated with higher cardiovascular and cancer screening participation in the low-SES population. In low-SES populations with limited access to pain management services, chronic pain issues may surface during routine health screening.
authors.affiliation: Singhealth Internal Medicine, Singapore General Hospital, Singapore.
authors.forename: Liang En
authors.initials: LE
authors.lastname: Wee
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
authors.forename: David
authors.initials: D
authors.lastname: Sin
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
authors.forename: Wen Qi
authors.initials: WQ
authors.lastname: Cher
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
authors.forename: Zong Chen
authors.initials: ZC
authors.lastname: Li
authors.affiliation: National Psychiatry Residency Program, National Healthcare Group, Singapore.
authors.forename: Tammy
authors.initials: T
authors.lastname: Tsang
authors.affiliation: Department of Anaesthesia, Ng Teng Fong General Hospital, JurongHealth, Singapore.
authors.forename: Sabina
authors.initials: S
authors.lastname: Shibli
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
authors.forename: Gerald
authors.initials: G
authors.lastname: Koh
keywords: Asian; Chronic pain; Health screening; Low-income; Mixed methods; Qualitative