Page 41 Guide to Pain Management in Low-Resource Settings

Ethnocultural and Sex Infl uences in Pain 29

damage to his fl esh. Th e scientists recorded the fakir’s imaging (a method by which scientists can record the ac-
behavior step by step throughout one of his shows and tivity of brain cells in people’s brains when they are per-
took blood from the veins in his arm and cerebrospi- forming certain mental activities or when the feel certain
nal fl uid from his spine through a “spinal tap” (a special sensations). Hypnosis makes the person more prone to
procedure which is performed by inserting a needle at suggestions, modifi es both perception and memory, and
the back of the spine, on the surface of the spinal cord). may produce changes in functions that are not normally
Th ey also recorded the fakir’s brain waves with an EEG under conscious control, such as sweating or the tone of
machine. Th roughout his performance, the fakir was blood vessels. Again, these studies are summarized in the
observed to stare ahead to some fi xed imaginary point popular science book, Beyond Pain [3].
and not blink for up to 5 minutes (normal people fl icker
their eyes several times every minute). As a matter of
How do we explain the diff erences
fact, the fakir was “somewhere else” in space and time, in pain perception and expression
not aware of his surroundings. However, when he fi n-
between ethnic groups?
ished his performance, he would return quickly to a
normal state of consciousness. Blood testing showed
that at the end of the act the fakir’s epinephrine (adren- Ethnic groups may have diff erent genetic make-ups and
aline) levels were high (similar to the adrenaline “rush” show distinct physiological and morphological charac-
thrill-seekers experience). However, his endogenous teristics (for example in the way certain drugs are me-
opioids (the body’s own pain killers) were not aff ected. tabolized, or in muscle enzymes after exercise). Howev-
EEG recordings showed that the fakir was switching er, the physical diff erences between people of diff erent
his brain waves from the alpha rhythm to slower theta cultures are less important than set beliefs and behav-
waves. Amazingly, while the fakir did not feel any pain iors that infl uence the thoughts and actions of the mem-
during his act, he complained bitterly (when he had re- bers of a given cultural/ethnic group.
turned to his normal state of mind) to the nurse who In regard to health care, patients have certain
pricked his arm to take blood for testing after his show! beliefs or explanations for their symptoms. Such be-
Another extreme example of cultural infl uenc- liefs result from interaction of cultural background,
es in reducing perception and expression of pain is the socioeconomic status, level of education, and gender.
procedure of “trepanation” (trephination or burr hole It is these beliefs that aff ect patients’ ideas about what
drilling) in East Africa. During the procedure, done up is wrong with them and what they should expect from
to the early 21st century for a number of reasons, the health care providers. Furthermore, the way patients re-
patients do not receive any form of analgesia or anes- port pain is shaped to a certain degree by what is sup-
thesia. Th e doktari or daktari (tribal doctor) cuts the posed to be the norm in their own culture. For example,
muscles of the head to uncover the bony skull in order some ethnocultural groups use certain expressions ac-
to drill a hole and expose the dura. Trepanation (evi- cepted in their own culture to describe painful physical
dence of which has been found even in Neolithic times) symptoms, when in reality they describe their emotion-
was done for both medical reasons, for example intra- al distress and suff ering. Research has shown that the
cranial pathology, and mystical reasons. During the description of physical pain (in reality refl ecting “emo-
procedure the patient sits calmly, fully awake, without tional pain”) is more often seen in the course of stressful
signs of distress, and holds a pan to collect the dripping events such as immigration to a new country, separa-
blood! I am not aware of any scientifi c studies that have tion from one’s family, changes in one’s traditional gen-
looked into this phenomenon, so gruesome for West- der roles, fi nancial diffi culties, and depression. Health
erners, but I would not be surprised if the “subjects” providers must then be able to recognize that diff erent
were using some method to change their state of mind cultures have diff erent beliefs and attitudes toward: (a)
and block pain (one is the change in brain waves I de- authority, such as the physician or persons in position
scribed above, another one is hypnosis). of power; (b) physical contact, as during physical exami-
Today, scientists have a better understanding of nation; (c) communication style in regard to the verbal
some of the altered states of mind. For example, hypno- or body language with which people communicate their
sis is considered an “altered state of consciousness” and feelings; (d) men or women health providers; and (e) ex-
has been well investigated with studies of functional pressing sexual or other issues.