CULTURAL ASPECTS OF PAIN MANAGEMENT
David E. Weissman, Deb Gordon, Shiva
Bidar-Sielaff
Studies have shown that patients from ethnic minorities and cultures
different from the health care professionals treating them, receive inadequate
pain management. Each of us has
the impression that people from distinct cultures are more or less likely to
express their pain experience in a manner that is somewhere between quietly
enduring (stoic) or very expressive.
Just ask yourself this question—what populations do you regularly
encounter that are more likely to be stoic, to be expressive? Now ask yourself a second question—do
you treat such patients who are stoic differently from those who are
expressive? Ideally, the answer
would be no, we should treat everyone the same. However, in truth, we are likely to provide more attentive
and compassionate care to the patient who is stoic compared to the expressive
patient. This is because the
culture of pain in Western Civilization tends to honor the stoic person (no
pain = no gain; the football player who makes a touchdown despite a broken
leg).
What is it about people that directs them to express their pain
experience in different ways? Culture is the framework that directs
human behavior in a given situation. The meaning and expression of pain are
influenced by people’s cultural background. Pain is not just a physiologic
response to tissue damage but also includes emotional and behavioral responses
based on individuals’ past experiences and perceptions of pain (e.g. when you
were a child was your expressive behavior tolerated or were you expected to be
stoic). Note: Not everyone in
every culture conforms to a set of expected behaviors or beliefs, so trying to
categorize a person into a particular cultural stereotype (e.g. all North
Dakota farmers are stoic) will lead to
inaccuracies. On the other hand,
knowledge of a patient’s culture may help you better understand their behavior.
Even more important than understanding the culture of others, is
understanding how your own upbringing effects your attitude about pain. We are likely to believe that our reaction to pain is “normal” and that
other reactions are “abnormal”. Thus a doctor or nurse from a stoic family may
not know how to react to a patient who responds to pain by loud verbal
complaints (or discount the pain because of the apparent mismatch between the
injury and the verbal response). Even subtle cultural and individual differences, particularly in
nonverbal, spoken, and written language, between health care providers and
patients impact care.
To be Culturally Competent,
you must:
·
Be aware of your
own cultural and family values
·
Be aware of your
personal biases and assumptions about people with different values than yours
·
Be aware and
accept cultural differences between yourself and individual patients
·
Be capable of
understanding the dynamics of the difference
·
Be able to adapt
to diversity
You must Listen with empathy to the patient’s perception of
their pain; Explain your
perception of the pain problem; Acknowledge the differences and
similarities in perceptions; Recommend
treatment; and Negotiate agreement. Questions that
staff can use to help assess cultural differences include:
·
What do you call
your pain? Do you have a name for it?
·
What do you
think caused your [pain]?; Why do you think it started when it did?
·
What does your
[pain] do to you?; How does it work?
·
How severe is
your pain? Will it have a long or short course?
·
What are the
most important results you hope to receive from the treatment?
·
What are the
main problems your [pain] has caused you?
·
What do you fear
most about your [pain]?
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Bates M.S., Rankin-Hill,
L., & Sanchez-Ayendez, M. (1997) The Effects of the Cultural Context of
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Edward E.
Rylander, M.D.
Diplomat American
Board of Family Practice.
Diplomat American
Board of Palliative Medicine.