embracing cultural perspectives in pain management
TRANSCRIPT
7/28/2019 Embracing Cultural Perspectives in Pain Management
http://slidepdf.com/reader/full/embracing-cultural-perspectives-in-pain-management 1/2
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
http://slidepdf.com/reader/full/embracing-cultural-perspectives-in-pain-management 2/2
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
References
1. Bates, M.S. Biocultural dimensions of chronic pain: implications
for treatment of multiethnic populations. State University of New
York Press, Albany, NY, 1996.
2. Cardosa M, Chen PP. Epidemiology in Chronic Pain, Gender
and Cultural Aspects, In: Tsui SL, Chen PP and Ng KFJ (ed):
Pain Medicine A Multidisciplinary Approach. Hong Kong
University Press, Hong Kong 2010, p 49-61.
3. Edwards CL, Fillingim RB, Keefe F. Race, ethnicity and pain.
Pain 2001; 94:133-7.
4. Lee A, Gin T, Oh TE. Opioid requirements and responses in
Asians. Anaesth Intens Care1997; 25:665-670
5. McKenzie KJ, Crowcroft NS. Race, ethnicity, culture, and science.
BMJ 1994; 309:286-7.6. Nicholas MK, Cardosa MS, Chen PP. Developing Multidisciplinary
Cognitive Behavioural Pain Management Programs in Asia. In:
Flor H, Kalso E, Dostrovsky JP (ed). Proceedings of the World
Congress in Pain, IASP Press Seattle, 2006, p773-87.
7.
Pain
2002; 100:291-298
8. Veerapen K, Wigley RD, Valkenburg H. Musculoskeletal pain in
Malaysia: a COPCORD survey. J Rheumatol. 2007;34:207-13.
9.
comparison of pain complaints.Pain 1988;32:177-183
10. Weisse CS, Sorum PC, Sanders KN, Syat BL. Do gender and
J Gen Intern Med
2001; 16:211–217.