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11.3 ABORIGINAL AND TORRES STRAIT
ISLANDER PEOPLES
Aboriginal and Torres Strait Islander peoples are a heterogeneous group both in terms of their
links to traditional cultural beliefs and links to the land, as well as in their degree of
urbanisation and understanding of Western biomedical concepts. The appropriate assessment
and treatment of pain in Aboriginal and Torres Strait Islander patients needs to take into
account a number of factors including cultural and language differences between the patient
and health care worker.
A study looking at issues associated with pain management in the palliative care setting in
rural and remote Aboriginal peoples interviewed patients, carers, Aboriginal health care
workers and other healthcare staff (McGrath, 2006 Level IV). While the focus was on palliative
care, many of the conclusions and comments made can be extrapolated to pain management
in general in this group of patients. The authors reported that Aboriginal patients may have a
higher pain threshold and be less likely to complain of pain (particularly men, who may not
want to appear weak by expressing their pain); there was also a fear of Western medicine.
Pain may also be seen as a punishment for some misdeed (Honeyman & Jacobs, 1996 Level IV).
The prevalence of musculoskeletal pain in general (Vindigni et al, 2004 Level IV) and back pain
specifically (Honeyman & Jacobs, 1996 Level IV) was reported to be high in non‐urban Australian
Aboriginal communities. However, it was uncommon for Aboriginal people to present with
pain as a complaint and public expression of pain and illness behaviours were uncommon,
including after painful injections in children and after acute injuries in adults (Vindigni et al, 2004
Level IV).
Aboriginal people may be reserved and unobtrusive when experiencing pain and health
professionals may mistakenly label them as stoic (National Palliative Care Program, 2006). Such
behaviour may lead to undertreatment of pain, and cultural issues, including marked shyness
with strangers (especially where there is a gender difference), gratuitous concurrence (saying
‘yes’ to be polite), different health belief systems and language differences, may further
complicate management (Howe et al, 1998 Level IV). Aboriginal people place a lot of importance
on non‐verbal communication so that words may be used only infrequently, they may avert
their eyes or turn their head away when questions are asked, hide under a blanket or feign
sleep (National Palliative Care Program, 2006).
Past unfortunate experiences with healthcare services can result in some not wishing to be
CHAPTER 11 may also be concerns about the use of morphine for the treatment of pain as some may
cared for in an acute care hospital, even though their treatment requires admission. There
believe that morphine hastens death and will therefore refuse to take pain relief medication;
discussions with the patient as well as family may be required and a specific person (as well as
the patient) may need to give consent before morphine is administered (National Palliative Care
Program, 2006). Therefore, despite having significant pain, some Aboriginal patients may
present late depending on access to health care facilities and attitudes to Western biomedical
models of health care. Provision of quality analgesia requires sensitivity to cultural practices
and beliefs, and behavioural expression of pain. Use of Aboriginal interpreters, health workers
and liaison officers to assess pain is beneficial as in some cases English skills, although present,
are limited and interpreters can help with non‐verbal communication issues.
A study of Aboriginal women after surgery found that they had culturally appropriate ways of
expressing and managing pain that were not well‐understood by non‐Aboriginal nurses
(Fenwick & Stevens, 2004 Level IV). It was reported that the Aboriginal women were generally
408 Acute Pain Management: Scientific Evidence
