Page 40 Guide to Pain Management in Low-Resource Settings

28 Angela Mailis-Gagnon

subjects called it simply “warm.” When subjects of dif- below are summarized by Mailis Gagnon and Israelson
ferent ethnic backgrounds were given electric shocks, in their popular science book, Beyond Pain [3].
women of Italian descent tolerated less shocks than
women of “old” American or Jewish origin. In another Can cultural infl uences increase
experimental study, when Jewish and Protestant women and decrease pain perception?
were told that their own religious group had not per-
formed well compared with others in an experiment To look at the complete opposite side, what about cul-
with electric shocks, only Jewish women were able to tural infl uences that can decrease instead of increase
tolerate a higher level of shock. Th e Jewish women in pain perception? In certain parts of the world such as
the fi rst place had tolerated lower levels of shocks to India, the Middle and Far East, Africa, some countries
start with. Since their cultural background was such of Europe, and among North American First Nations,
that they easily complained of pain, they had “more ability to endure pain is considered a proof of special
room to move” in terms of additional shock stimulus. access or relationship to the gods, a proof of faith, or
On the other hand, in a clinical study of six readiness to “become an adult” during “initiations” or
ethnic groups of pain patients (including “old” Ameri- “rituals.” Such rituals have puzzled and amazed Western
can, Hispanic, Irish, Italian, French Canadian, and Pol- scientists for many years. An example of such a ritual
ish pain patients), the Hispanics specifi cally reported is the phenomenon of “hook-hanging,” which is prac-
the highest pain levels. Th ese patients were character- ticed primarily by certain devotees to Skanda, the god of
ized by an “external locus of control” (the belief that life Kataragama in Sri Lanka. Dr. Doreen Browne, a British
events are outside the person’s control and in the hands anesthetist, visited Sri Lanka in 1983 and described her
of fate, chance, or other people). In yet another clinical observations. Th e fl esh of the back of the devotees was
study, patients in a pain center in New England, USA, pierced by several hooks, and the subjects were hung
were compared with those in an outpatient medical and swung from scaff olds pulled by animals, visiting vil-
center in Puerto Rico. Th e Puerto Ricans (Hispanics or lages to bless the children and the crops. Th e subjects
Latinos) were found to experience higher pain levels in seemed to stare far away and at no time did they seem
general (in accordance with the other study mentioned to feel pain; as a matter of fact, they were in a “state
above). Such a fi nding indeed supports the long-held of exaltation.” Th e training of these devotees starts in
belief that Latino cultures are more reactive to pain. childhood and they seem to gradually develop the abil-
However, when the researchers studied Puerto Ricans ity to switch to a diff erent state of mind that could block
who had immigrated to New England, USA, many years pain. Indeed, a German psychiatrist, Dr. Larbig, showed
before, their reactions were more like those of the New with electroencephalographic (EEG) studies that the
England group than their original Puerto Rican group. devotees’ brainwaves change throughout all the stages
Th is fi nding shows that pain responses of diff erent eth- of the process. It is well known that our brains emit dif-
nic groups can change, as they are shaped and reshaped ferent wave frequencies during activities or sleep. Alpha
by the culture in which the groups live or move into. In waves are emitted during our regular conscious activi-
studies among patients with cancer, Hispanics report- ties, and they are fairly fast at 8–13 cycles every sec-
ed much worse pain and quality of life outcomes than
ond. Another kind of brain waves called theta waves are
Caucasians or African Americans. On the other hand,
slower at 4–7 cycles per second and occur during light
Hispanic cancer patients use religious faith as a pow-
sleep or when the individual detaches from reality to
erful resource in coping with pain. African Americans
become absorbed in deep thoughts. Th e hook-hanging
complain of more pain than Caucasians during scoliosis
devotees actually displayed theta waves throughout all
surgery, while Mexican-Americans report more chest
and upper back pain than non-Hispanic whites during a the stages of the process (i.e., during insertion of the
myocardial infarction. Another real-life example of how hooks, swinging, and removal of the hooks).
culture shapes people’s reactions to painful events is the Dr. Larbig was also fascinated by the amaz-
fact that only 10% of adult dental patients in China rou- ing things that fakirs do and investigated a 48-year-old
tinely receive local anesthetic injections from their den- Mongolian fakir. Th is man could stick daggers in his
tist for tooth drilling compared with 99% of adult pa- neck, pierce his tongue with a sword, or prick his arms
tients in North America. All these studies and the ones with long needles without any indication of pain or