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Strategies used to facilitate cross‐cultural pain education and management include bilingual
handouts describing varying methods of pain control and VAS scales with carefully chosen
anchor terms or the use of faces scales (see Section 2); the NRS, for example has been
translated and validated in many languages (Davidhizar & Giger, 2004). A series of pain scales in
a number of different languages has also been produced by the British Pain Society to assist in
the assessment of people whose first language is not English and these are available on their
website (British Pain Society, 2009).
While there is some evidence of differences in pain reports and analgesic use in different
cultures or ethnic groups, it should not be used to stereotype patients or promote
assumptions about differences in assessment and management of pain or response to pain
therapies. Provision of effective analgesia requires sensitivity to a patient’s cultural practices
and beliefs, and their behavioural expression of pain. However, the large inter‐individual
differences in pain behaviours and analgesic requirements that exist in any patient group
mean that pain is best assessed and managed on an individual basis rather than on the basis of
what might be ‘expected’ in a patient from a particular cultural or ethnic background.
Key messages
1. Disparities in assessment and effective treatment of pain exist across ethnic groups (N)
(Level III‐3).
The following tick boxes represent conclusions based on clinical experience and expert
opinion.
Ethnic and cultural background can significantly affect the ability to assess and treat acute
pain (U).
Multilingual printed information and pain measurement scales are useful in managing
patients from different cultural or ethnic backgrounds (U).
Differences between different ethnic and cultural groups should not be used to stereotype
patients and lead to assumptions about responses to pain or pain therapies; pain
assessment and management should be done on an individual patient basis (N).
11.5 THE PATIENT WITH OBSTRUCTIVE SLEEP APNOEA
Acute pain management in a patient with obstructive sleep apnoea (OSA) presents two main
problems: choice of the most appropriate form of analgesia and the most suitable location in
which to provide it. These difficulties arise primarily from the risk of exacerbating OSA by the
administration of opioid analgesics. CHAPTER 11
Approximately one in five adults have at least mild OSA, one in fifteen have moderate or
worse OSA and 75% to 80% of those who could benefit from treatment remain undiagnosed
(Young et al, 2004). Therefore, many patients with undiagnosed OSA will have had treatment for
acute pain without significant morbidity. This implies that the overall risk is quite low.
Despite the low risk, it has been reported that patients with OSA may be at increased risk of
postoperative complications compared with other patients. However, it is possible that the
risk lies more with the body size and build of the patient, especially those who are morbidly
obese, rather than the fact they have a diagnosis of OSA (Loadsman 2009).
A significantly higher incidence of serious postoperative complications (including unplanned
ICU admissions, reintubations, and cardiac events) and longer hospital stay after joint
replacement surgery was reported in patients with OSA compared with matched controls
Acute pain management: scientific evidence 411
