Page 39 Guide to Pain Management in Low-Resource Settings

Chapter 5

Ethnocultural and Sex Infl uences in Pain

Angela Mailis-Gagnon

Case reports health care providers. Maryann Bates [1], a professor at
the School of Education and Human Development at
A 40-year-old male patient comes to see you. He is Chi- the State University of New York, studied pain patients
nese and has been in a Western country for 2 years. His of diff erent ethnic backgrounds. Bates proposed that
English is barely functional. While you try to obtain in- culture refl ects the patterned ways that humans learn
formation for the neck pain that brought him to you, he to think about and act in their world. Culture involves
keeps looking to the ground and avoids eye contact. Is he styles of thought and behavior that are learned and
depressed or does he simply disrespect you? shared within the social structure of our personal world.
A 25-year-old woman with a hijab and tradi- In this context, culture is diff erent than ethnicity. Th e
tional Moslem attire is brought in by her husband in re- latter refers specifi cally to the sense of belonging in a par-
gard to diff use body pain complaints. She looks uncom- ticular social group within a larger cultural environment.
fortable when she realizes that the clinic doctor who will Th e members of an ethnic group may share common
see her is a male. Given the fact that this doctor is the traits such as religion, language, ancestry, and others.
only one available at that time, how is he going to handle
the problem?
Why is it important to understand
A 75-year-old farmer with elementary school
education sees you for severe knee arthritis. He cannot ethnicity and culture when it comes
tolerate nonsteroidal anti-infl ammatory medications to pain diagnosis and management?
and refuses knee surgery. His pain responds very well to
Culture and ethnicity aff ect both perception and ex-
small doses of controlled-release morphine. However, he
pression of pain and have been the focus of research
becomes very nauseated and throws up every time. He
since the 1950s. Research with adult twins supports
becomes visibly upset when you off er him Gravol sup-
the view that it is the cultural patterns of behavior and
positories after you explain to him how to use them. Why
not our genes that determine how we react to pain.
do you think he became angry, and how are you going to Examples of how culture and ethnicity aff ect pain per-
address this problem? ception and expression are numerous, both in the lab-
Th ese are common clinical problems seen by oratory and in clinical settings.
primary care physicians as well as pain clinics and are In the laboratory, an earlier classic study showed
examples of how cultural and ethnic background af- that persons of Mediterranean origin described a form
fects pain perception, expression, and interactions with of radiant heat as “painful,” while Northern European
Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 27
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
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recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.