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silent about their pain even when asked, and that, in part at least, this arose from fear of pain
(including its origin and significance in relation to themselves and the external world) and a
belief that the nurses would know about the pain they were experiencing so that there was no
need to tell them. In addition, access to appropriate pain relief may be more limited. In one
Central Australian hospital, fewer Aboriginal patients were referred to the APS than non‐
Aboriginal patients, despite being the predominant patient group in that institution (Fenwick &
Stevens, 2004).
Pain assessment by some conventional methods may not be appropriate. A verbal descriptor
scale but not a numerical rating scale was a useful measure of pain (Sartain & Barry, 1999
Level III‐3). This is consistent with the fact that specific numbers and numerical scales are not
part of many Aboriginal language systems and more descriptive terms are used for
quantification.
Aboriginal and Torres Strait Islander peoples can use PCA effectively if given adequate
information about the technique. However, communication is often difficult and so techniques
such as continuous opioid infusion techniques tend to be used more commonly in Aboriginal
and Torres Strait Islander peoples than in other patient groups (Howe et al, 1998 Level IV). In
addition, consent for invasive procedures such as epidural analgesia may be difficult to obtain;
there may be communication difficulties or the patient may need to discuss the proposed
consent with other members of the family.
Medical comorbidities such as renal impairment and diabetes are more common in Aboriginal
and Torres Strait Islander peoples as well as New Zealand Maoris (Howe et al, 1998 Level IV;
Bramley et al, 2004 Level IV; McDonald & Russ, 2003 Level IV). This may affect the choice of
analgesics (see Section 11.6).

Key messages
1. The verbal descriptor scale may be a better choice of pain measurement tool than verbal
numerical rating scales (U) (Level III‐3).

2. Medical comorbidities such as renal impairment are more common in Aboriginal and
Torres Strait Islander peoples and New Zealand Maoris, and may influence the choice of
analgesic agent (U) (Level IV).

3. Clinicians should be aware that pain may be under‐reported by this group of patients (U)
(Level IV).
The following tick boxes  represent conclusions based on clinical experience and expert
opinion.
 Communication may be hindered by social, language and cultural factors (U).
 Provision of quality analgesia requires sensitivity to cultural practices and beliefs, and CHAPTER 11
behavioural expressions of pain (N).

11.4 DIFFERENT ETHNIC AND CULTURAL GROUPS

Australia is a culturally diverse nation with a relatively large immigrant population. In the 2006
Census, 71% of people were born in Australia and English was the only language spoken at
home by 79% of these. The four most common languages used at home other than English
were Chinese languages (2.3%), Italian (1.6%), Greek (1.3%) and Arabic (1.2%) (Australian
Bureau of Statistics, 2006). In many other countries in the world there is also significant cultural
and ethnic diversity.
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