Fast Fact and Concept #78: Cultural aspects of pain management

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Title: Fast Fact and Concept #78: Cultural aspects of pain management

Author(s): Weissman, David E; Gordon, Deborah; Bidar-Sielaff, Shiva

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:

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:


Bates M.S., Rankin-Hill, L., & Sanchez-Ayendez, M. (1997) The Effects of the Cultural Context of Health Care on Treatment of and Response to Chronic Pain and Illness. Social Science and Medicine, 45(9). 1433-1447.

Berlin EA Fowkes WC. A teaching framework for cross-cultural health care. WJMed 1983;139:934-938.

Kleinman AK, Eisenberg L, Good B. Culture illness and care. Clinical lessons from Anthropologic and cross-cultural research. Ann Int Med 1978;88:251-258.

Morrison RS, Wallenstein S, Natale DK, Senzel RS, Huang LL. "We don't carry that" - failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. N Engl J Med 2000;342:1023-1026.

University of Wisconsin Hospital & Clinics, Pain Patient Care Team.

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Fast Facts and Concepts #78 Cultural aspects of pain management. Weissman D Gordon D, and Bidar-Sielaff S. October 2002. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.

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Creation Date: 10/2002

Format: Handouts

Purpose: Instructional Aid, Self-Study Guide, Teaching

Training: Fellows, 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice
Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
Non-Physician: Clergy/Chaplains, General Public, Graduate Students, Lawyers, Patients/Families, Nurses, Social Workers

ACGME Competencies: Interpersonal and Communication Skills, Patient Care

Keyword(s): Addiction, Chronic non-malignant pain, Controlled substance regulations, Cross-cultural care, Pain, Pain assessment, Pain treatment, Personal reflection

The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).