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AREAS OF CULTURAL VARIATION
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POINTS TO CONSIDER
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SUGGESTIONS
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Reaction to pain and expression of pain
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- Cultures vary in what is considered acceptable expression of pain. As a result, expression of pain will vary from stoic to extremely expressive for the same level of pain.
- Some men may not verbalize or express pain because they believe their masculinity will be questioned.
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- Do not mistake lack of verbal or facial expression for lack of pain. Under-treatment of pain is a problem in populations where stoicism is a cultural norm.
- Because the expression of pain varies, ask the patient what level, or how much, pain relief they think they need.
- Do not be judgmental about the way someone is expressing their pain, even if it seems excessive or inappropriate to you. The way a person in pain behaves is socially learned.
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Spiritual and religious beliefs about using pain medication
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- Members of several faiths will not take pain relief medications on religious fast days, such as Yom Kippur or daylight hours of Ramadan. For these patients, religious observance may be more important than pain relief.
- Other religious traditions forbid the use of narcotics.
- Spiritual or religious traditions may affect a patient’s preference for the form of medication delivery, oral, IV, or IM.
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- Consultation with the family and Spiritual Counselor will help you assess what is appropriate and acceptable. Variation from standard treatment regimens may be necessary to accommodate religious practices.
- Accommodating religious preferences, when possible, will improve the effectiveness of the pain relief treatment.
- Offer a choice of medication delivery. If the choice is less than optimal, ask why the patient has that preference and negotiate treatment for best results.
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Beliefs about drug addiction
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- Recent research has shown that people from different genetic backgrounds react to pain medication differently. Family history and community tradition may contain evidence about specific medication effects in the population.
- Past negative experience with pain medication shapes current community beliefs, even if the medications and doses have changed.
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- Be aware of potential differences in the way medication acts in different populations. A patient's belief that they are more easily addicted may have a basis in fact.
- Explain how the determination of type and amount of medication is made. Explain changes from past practices.
- Assure your patient you are watching their particular case.
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Use of alternative pain relief treatment
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- Your patient may be using traditional pain relief treatment, such as herbal compresses or teas, massage, acupuncture or breathing exercises.
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- Respectfully inquire about all of the ways the patient is treating their pain.
- Use indirect questions about community or family traditions for pain management to provide hints about what the patient may be using. There may be some reluctance to tell you about alternative therapies until they feel it is "safe" to talk about them.
- Accommodate or integrate your treatments with alternative treatments when possible.
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Methods needed to assess pain
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- Most patients are able to describe their pain using a progressive scale, but others are not comfortable using a numerical scale, and the scale of facial expressions (smile to grimace) may be more useful.
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- Ask the patient specifically how they can best describe their pain.
- Use multiple methods of assessing pain - scales and analogies, if you feel the assessment of pain is producing ambiguous or incorrect results.
- Once the severity of the pain can be assessed, explain in detail the expected result of the use of the pain medication in terms of whatever descriptive tools the patient has used. Check comprehension with teach-back techniques.
- Instead of using scales, which might not be known to the patient, asking for comparative analogies, such as "like a burn from a stove," "cutting with a knife," or "stepping on a stone," may produce a more accurate description.
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