Page 43 Guide to Pain Management in Low-Resource Settings

Ethnocultural and Sex Infl uences in Pain 31

role, even if the investigators were not exactly sure what pain experiences and clinical pain conditions;
behavioral, genetic, or other determinants of ethnicity develop culturally sensitive models for assessing
were involved. and treating pain and methods to disseminate
b) In the Women’s Health Surveillance Report such information; and document progress toward
from Statistics Canada, which surveyed approximately eliminating disparities in pain management and
100,000 households, the proportion of South (Central) evaluate pain management outcomes.
Asians who reported chronic pain was much greater • A word of caution: Ethnocultural research is not
than any other ethnic group in the Canadian population without diffi culties. For example, simply grouping
over 65 years old (with 38.2% of the males and 55.7% of American people into blacks, Hispanics. and “old
the South Asian females reporting chronic pain). Americans” (white Anglo-Saxons whose families
c) In a large cross-sectional study from a Canadian have lived in the United States for several gen-
pain clinic [4], women signifi cantly outnumbered men erations), fails to appreciate the massive social,
but presented with lower levels of physical pathology cultural, and economic diff erences between de-
in almost all (Canadian-born or foreign-born) groups. pendents of people brought to America 2–3 cen-
Noticeably, nearly one in two South Asian women was turies ago and the millions of recent immigrants

classifi ed to have high pain disability in the absence of from diff erent parts of the world, who may have
physical pathology, the highest percentage of all female adopted the culture of the group into which they
subgroups. Th e researchers felt that maybe these pa- moved to variable degrees or are of mixed back-
tients were sent by their doctors to the pain clinic with ground through intermarriage.
physical complaints, while in reality they were suff ering • Th erefore, future studies will have to take nu-
from emotional distress. Th is may indeed make sense merous factors in account in order to refl ect the
because South Central Asians constitute the most re- complex reality of culture and ethnicity and their
cent wave of immigrants to Canada, and therefore stress infl uence not only in pain perception and expres-
of immigration may be substantial. sion, but also in health care utilization and treat-
ment outcomes.
Pearls of wisdom
References
• Ethnocultural research is in its infancy. Williams
[5] stressed that racial and ethnic identifi ers (such [1] Bates MS. Biocultural dimensions of chronic pain. SUNY Series in
Medical Anthropology. Albany, NY: State University of New York Press;
as language spoken at home, country of birth, 1996.
race, etc.) are necessary to document pain dis- [2] Cooper LA, Beach MC, Johnson RL, Inui TS. Delving below the sur-
face. Understanding how race and ethnicity infl uence relationships in
parities in clinical situations; plan and implement health care. J Gen Intern Med 2006;21:S21–7.
[3] Mailis-Gagnon A, Israelson D. Beyond pain: making the body-mind
prospective studies to detect disparities; develop connection. Viking Canada; 2003.
and evaluate pain assessment tools that refl ect [4] Mailis-Gagnon A, Yegneswaran B, Lakha SF, Nicholson K, Steiman AJ,
Ng D, Papagapiou M, Umana M, Cohodarevic T, Zurowski M. Ethno-
cultural, ethnic, and linguistic diff erences; clarify cultural and gender characteristics of patients attending a tertiary care
the role of both patients and physicians’ ethnicity pain clinic in Toronto, Canada. Pain Res Manage 2007;12:100–6.
[5] Williams DA. Racial and ethnic identifi ers in pain management: the im-
in pain management; examine racial and ethnic portance to research, clinical practice and public health policy. Ameri-
can Pain Society; 2004. Available at: http://ampainsoc.org/advocacy/
diff erences in pain perception, beliefs, attitudes, ethnoracial.htm.
and behaviors that may underlie diff erences in