Musculoskeletal/chronic pain assessment during nurse based screening clinics for non-communicable diseases: Kenya

Policy makers in global health have shifted towards recognition of non-communicable diseases (NCDs) as a growing threat to the well-being of individuals in under resourced countries. Yet musculoskeletal conditions (MSK) are not among those formally recognized NCDs. On previous screenings in Kenya a nearly universal complaint of MSK pain was noted. We sought to further characterize these patients and begin to define practical treatments in extremely resource-limited environments. Patients were seen in 5 screening clinics, one urban and four rural around Nairobi. In addition to cardiovascular disease (CVD) risk assessment, a series of questions were asked, in native language, re: pain including demographics, perceived health, daily pain presence, pain location, chronicity, pain-limited activity; depression and stress. The clinics were conducted by US/Kenyan teams comprised of nursing students, faculty and clinic staff. A subset of patients were seen and offered treatment including medication and individualized recommendations. Practical tips for easing, limiting or preventing low back or knee pain were provided through brochures in Kiswahili developed for this project. Chronic pain, most likely OA, is common among patients presenting to a screening clinic for CVD risks. Patients (n=858) were black, Kikuyu ethnicity; mean age 55 yrs (±17.4), 79% female. 63% reported daily pain; 50% for months or years duration (chronic pain); 40% at multiple sites, 33% lower extremity, 25% low back, 22% upper extremity. Pain was significantly associated with older age (p<.001), perceived fair/poor health (p<.001) and systolic BP>140 (p<.005). Of those reporting daily pain;80% reported chronic pain, 51% increased stress, 48% had BMI>=25 and 65% reported pain-limited activity. NCD risk assessment by nursing students and clinic staff in rural and urban health clinics in Kenya afford an opportunity to address pain management, provide prevention skills and population interventions in extreme resource-limited areas.