Embracing Cultural Perspectives in Pain Management

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IntroductionAccording to the biopsychosocial model of pain, race,ethnicity and culture would be important contributorsto pain and have to be considered in our managementapproaches to pain, especially in chronic painpatients. Although the three terms (“race”, “ethnicity”and “culture”) are often used interchangeably, race isbiologically determined, while ethnicity and cultureare social constructs. In addition to understanding

and expression of pain in patients, we should also

and cultural backgrounds.

Ethnic dierences in pain: Experimentaland clinical data

in various racial groups within and between countries.Laboratory and clinical studies have shown evidence

groups. However there were also studies that showed

have also been found in the reporting of pain as wellas the social impact of pain (e.g. depression, fear)

such as AIDS, arthritis and low back pain.

Ethnic and cultural stereotyping has been shown to

to under-treatment of pain in some cases. However,in cases where the analgesia was self-administered bya patient-controlled analgesia technique, the eventual

Biological, social and psychological mechanismsin pain responses and expressionA variety of biological, social, and psychologicalmechanisms may be responsible for observed racial

to pain has been linked to mutation of the geneSCN9A, and it is equally possible that other genesor mutations may make individuals more sensitiveor susceptible to pain, especially the development of chronic persistent pain. However, cultural patternsof behaviour within families were also found todetermine sensitivity to pain. Cultural and ethnicfactors, including practices such as meditation, may

modulate pain through the activation of descendingneural inhibitory controls. Psychological factors

pain and subsequent disability, and ethnic factors may

responses, including treatment-seeking behaviour,

cultural responses may change with assimilation

integrate into a foreign society being shown to behaveand respond to pain according to the expectations andvalues of their adopted society.

EMBRAC ING CULTURAL PERSPECTIVESIN PAIN MANAGEMENT

Dr Mary Suma CardosaHospital Selayang, Selangor, Malaysia

7/28/2019 Embracing Cultural Perspectives in Pain Management

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Implications for management: Experiencesin Asian populationsExperience with chronic pain patients in Malaysia and

cultural backgrounds and beliefs compared to patientsfrom western cultures, there are a lot of similarities inthe responses of the patients to chronic pain, and theresulting distress and disability. Similarly, cognitivebehavioural therapy (CBT) based pain managementprograms that teach self-management strategies forchronic pain, although developed in the west, havebeen applied successfully in Malaysian and HongKong patients. These programs are conducted usinglocal languages, applying CBT principles but usingculturally appropriate examples and illustrations sothat they are meaningful to the patients.

Conclusion

activity and mood are multiple and may impact on the

Additionally, and more importantly, gender and

treatment due to health care professionals’ prejudices

backgrounds. Thus an awareness of cultural and

is essential to ensure that management of patientswith acute and chronic pain - especially those fromminority groups – is carried out equitably and

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