Original ArticlesCulture, pain, and culturally sensitive pain care☆,☆☆
Section snippets
Culturally oriented pain education
Unlike most other early cancer pain education initiatives, the Boston Cancer Pain Education Program (BCPEP) stressed cultural diversity and minority status. In addition, the BCPEP aimed its educational efforts at both nurses, patients, and their family members. Funded by the National Cancer Institute, we educated over 500 nurses spanning the care continuum of home, hospital, and hospice, who in their daily work encountered patients from a broad range of cultures other than their own. At
Culturally relevant barriers to pain control
Culture has a vital influence on illness beliefs and behaviors, health care practices, help-seeking activities, and receptivity to medical care interventions (Good, Brodwin, Good, & Kleinman, 1992; Harwood, 1981; Kleinman, 1980; Leininger, 1991; Meinhart & McCaffrey, 1983; Spector, 1991; Varrichio, 1987). Western-trained clinicians view the medical care system as technologically sophisticated and helpful in the curing process. However, patients may fear hospitals as places to die and may
The importance of a cultural assessment
A variety of differences exist both between and within cultural groups (Harwood, 1981; Kleinman, 1980; Lee & Fong, 1990; Meinhart & McCaffrey, 1983; Rowell, 1990). Because of diversity both between and within cultures, it is important for the clinician not to make stereotypic judgments based on a person's ethnic heritage but to conduct a cultural assessment of the patient. Clinicians need to pay attention to inter- and intracultural differences. Table 1 provides a tool that nurses can use to
Research on culture and pain
Early research on the relationship of culture and pain, conducted by 2 sociologists (Zborowski, 1960; Zola, 1963), found that reactions to pain varied by cultural group and reflected the beliefs of the group. More recently, epidemiologists, clinical epidemiologists, psychologists, nurses, physicians, and anthropologists are among the disciplines that have sought to explain how culture is related to pain. Laboratory studies (Garron & Leavitt, 1979; Lipton & Marbach, 1984) tend to report that
Cultural sensitivity in the clinical encounter
Cultural coding and encoding within the context of a clinician and patient interaction is not a one-way street. Not only do the patient and family members bring their own distinctive cultural background, but clinicians have their own personal cultural background as well as the overriding culture provided by their training in western biomedicine. The “culture” of a hospital, hospice, or home health care agency must not be overlooked because it influences how well an institution works and how
Providing culturally sensitive pain care
In approaching any patient in pain, the first rule is to avoid cultural stereotyping and to be open, authentic, sensitive, and caring. Culture is, above all, an involving process. The more that is learned about the cultural features of a particular patient population, the better equipped the clinician will be to work effectively with patients in pain. However, it is not just a matter of formal training. Clinicians need to read books and articles about various cultural groups within their
The role for the American Society of Pain Management Nurses
Nurses are considered the cornerstone of good pain management because they often know the patient better than the rest of the health care team. The American Medical Association recently established a new website featuring nearly 500 pages devoted to cultural diversity and competency. Some, but not much, of this material has come from nurses and other allied health professionals. Yet, nurses have made substantial contributions to cultural sensitivity and because of their close relationship with
References (48)
- et al.
Physician and patient factors influencing the treatment of low back pain
Pain
(1997) Postsurgical pain relief: Patients' status and nurses' medication choices
Pain
(1980)Pain syndromes in patients with cancer
Medical Clinics of North America
(1987)- et al.
Ethnicity and the pain experience
Social Science and Medicine
(1984) - et al.
The effect of ethnicity on prescriptions for PCA for post-operative pain
Pain
(1996) - et al.
Cancer disparities between African Americans and whites in Missouri
Taking Control of Your Pain
(1996; 1997)Cancer Facts & Figures.
(1998)- et al.
Management of pain in elderly patients with cancer
Journal of the American Medical Association
(1998) Management of cancer pain: Recent results
Cancer Research
(1984)
Evaluation of the pain response by Mexican American and Anglo American women and their nurses
Journal of Advanced Nursing Practice
Factors influencing physician management of cancer pain
Cancer
Research in cancer pain: What we know and what we need to know
Cancer
Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group minority outpatient pain study
Annals of Internal Medicine
The prevalence and severity of pain in cancer
Cancer
Knowledge and beliefs regarding pain in a sample of nursing faculty
Journal of Professional Nursing
The treatment of cancer pain
New England Journal of Medicine
Demographic and affective covariates of pain
Psychosomatic Medicine
The effect of cancer pain on quality of life in different ethnic groups: A literature review
Nursing Practice Forum
Pain as human experience: An anthropological perspective
Does sharing a mother-tongue affect how closely patients and nurses agree when rating patient's pain, worry, and knowledge?
Journal of Advanced Nursing Practice
The unequal burden of cancer: An assessment of NIH research and programs for ethnic minorities and the medically underserved
Patients and healers in the context of culture: An exploration of the borderline between anthropology, medicine, and psychiatry
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Understanding Nurse Characteristics that Influence Assessment and Intention to Treat Pain in Postoperative Patients: An Integrative Literature Review
2022, Pain Management NursingCitation Excerpt :There were no studies that specifically focused on how to change nurse attitudes or biases. As patient and nurse populations within a country become increasingly diverse (Leininger, 2002), an understanding of cultural beliefs about what pain means, the influence of culture on pain expression, and expectations of pain relief are of paramount importance to ensure effective pain relief for postoperative patients (Green et al., 2003; Lasch, 2000). A recent paper provided expert opinion that culture can have an effect on pain expression and management (Bautista et al., 2021).
Comparison of Four Pain Scales Among Hmong Patients with Limited English Proficiency
2021, Pain Management NursingRacial/Ethnic Differences in Staff-Assessed Pain Behaviors Among Newly Admitted Nursing Home Residents
2021, Journal of Pain and Symptom ManagementCitation Excerpt :Differences in cultural and social norms impact the expression of emotions among different racial/ethnic groups,53,54 with some cultures promoting more stoic expressions of pain,19 making accurate perception of pain55 more difficult for nursing home staff. Providers whose cultural experience and knowledge differs from that of the residents they care for may interpret resident emotional expressions and behaviors through a different lens, if the provider is not cognizant of this difference, and does not account for it during the assessment.56–58 Differences in attitudes and beliefs about the origin and role of pain influence how individuals perceive and react to their pain as well as the pain of others.54–56
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2024, Journal of Racial and Ethnic Health DisparitiesRacial Disparities in Pain Among Women with Fibromyalgia: Secondary Data Analysis of Severity, Interference with Function, and Response to Guided Imagery
2023, Journal of Integrative and Complementary Medicine
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Supported by grants from the National Cancer Institute (CA 60343 and CA 65055).
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Address correspondence and reprint requests to Kathryn Lasch, PhD, MA, MSSW, The Health Institute, New England Medical Center, 750 Washington St, Box 345, Boston, MA 02111.