PSY 8307 Week 6 Stoll, E

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Ethnocultural Issues and Managing Pain Emily Chester Stoll PSY 8307 Week 6 February 27, 2022

Pain can be described as any physical suffering one endures due to injury or illness and even stress. Pain that is derived from an injury is often more easily diagnosed. For example, if someone falls and hurts their hip, the pain from the hip can pinpointed. However, different culture’s view pain in different ways. Some cultures are more stoic in their response to pain, keeping to themselves and informing no one. Pain can manifest due to a myriad of things. Grief from the loss of a loved one could manifest into pain. As many ways that pain can appear, there are ample ways of coping and interventions available. Self-preservation becomes instrumental in how one chooses to deal with their pain management. Educating different clients in different communities, “health professionals can teach clients the adaptive role of the stress response to episodic stressors and the detrimental physical and psychological effects caused by chronic long- term stress” that could lead to physical or mental pain (Collins, et al., 2003, p. 169). Common physical pain is often a part of life. Some deal with migraines due to stress. Some suffer from recurring aches from previous injuries. The concept of pain management is perceived differently by each individual. In an attempt to create a way for each individual to convey their pain, Wong and Baker created a face pain scale. This is a 0-10 scale using face drawings to determine the level of pain being experienced. Initially intended to understand the pain in children, this scale is still widely used for patients of all ages (Wong & Baker, 1988). Having this tool can help health care professionals understand their patients’ perception of their pain. However, when looking at different cultures, what an individual will share with their family and health care provider can vary. For example, women suffering from endometriosis (ED) suffer from chronic pain. It is an illness that affects every ethnicity globally, and there is no cure. When looking specifically at women with endometriosis, their pain is a daily concern. Some ethnic groups avoid seeking help

because it is thought that a woman’s menstruation is part of being a woman. In many cultures, it is expected for women to endure it without complaints as a natural part of life. “A person’s culture determines how pain is perceived, experienced and communicated” (Peacock & Patel, 2008, p. 6). ED does not have a specific pathology. Why it effects an estimated 10% of the global population has not been firmly established. How these women from different cultures endure the pain varies. Furthermore, how different cultures cope with pain and the management of is broad. Psychologists remain aware that different ethnicities may present different responses and stressors to everyday life. It is to be noted that endometriosis is more common in Caucasian and Asian American women than their counterparts. Despite different ethnicities and geographical locations, most women have reported feeling some sort of stigma when disclosing their endometriosis. “Understanding coping behaviors over time can help researchers and practitioners implement programs to improve coping efficiency and adjustment” with their patients (Heffer & Willoughby, 2017, p. 12). Positive and negative coping strategies can be seen in all populations. “Ethnic diversity means clinicians are regularly required to meet the needs of people from different cultures and offer culturally relevant health care” (Peacock and Patel, 2008, p. 6). Peacock and Patel (2008) present an interesting study showing that those who have the same pain reports, despite being raised in other cultures, often experience acculturation which is defined as someone “who migrates from the country of birth, adopts the values, beliefs, cultures and lifestyles of the country to with they emigrate” (Peacock and Patel, 2008, p. 6). The role of culture in chronic pain should analyzed and taken into account with health care professionals because the patient’s pain can directly affect their ability to maintain a steady home and social life. Constant physical pain leads to a negative impact on the ability to work,

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family relationships and self-esteem. Self-esteem stems from individual and social influences. Having family educated and informed of the diagnosis can greatly improve the mental well- being by creating a sense of understanding and support. Often, this is a positive mitigating coping strategy which decreases stress and reduces the likeliness of physical pain arising due to that factor. A study conducted by Steinhardt (2009) revealed that individuals appreciated group sessions and reported that it influenced their resilience with handling pain (Steinhardt, et al., 2009). This study focused on African American adult with type 2 diabetes, but the results could easily translate to many different shared typed of pain. Again, having knowledge and understanding of their pain, health care professionals and those around them can better help them cope with their chronic pain more effectively. How people cope with their pain can also have a significant impact on chronic pain […] believing that physicians or traditional healers are responsible for the treatment or even ‘cure’ of pan can be detrimental to pain management (Sharma, et al., p. 345). Addressing culture may lead to finding better ways of being more patient-focused and using it to determine with coping interventions may work for that individual. For many cultures, pain is part of the life experience and not something that is to be complained about. Yougjun, et al., (2020), conducted a survey of those suffering with chronic pain in China. The research took a large participant population of 31 provinces to investigate how pain was received across the different Chinese populations and to show the difference between that and populations elsewhere. Despite showing a difference in the morbidity of chronic pain from London, England, America, etc., China showed a high rate of pain, but a low rate of treatment (Youngjun, et al., 2020). This can only show that the Chinese culture views pain as a different stress factor in their life. Often, studies have reported that Asian cultures turn to complimentary

alternative medicine to mitigate pain instead of relying on traditional medicine and surgeries (Rathi, et al., 2021). In Rathi, et al., the study showed that despite refugees choosing CAM as a means of pain treatment, they were often somewhat reluctant in their physicians understanding the practice (Rathi, et al., 2021). CAM interventions including acupuncture and biofeedback are all reported to have positive health benefits and help with pain management. Resilience is key to understanding how culture plays in providing help. Like ED, Type 2 Diabetes is a chronic condition. There is greater stress and higher levels of depression associated with both (Steinhardt, et al., 2009). Both can lead to physical pain that may be mitigated by CAM interventions, social support, and healthcare providers giving them full information on all possibilities to improve quality of life. Each individual will experience pain and stressors differently. However, in gaining the means and informing patients of the options, achieving a normal life is attainable. Individuals should remain encouraged that combining different techniques with medicine or surgery could lead to celebrating relief. Increasing awareness on options, healthcare providers can be instrumental in helping patients improve quality of life by reducing the stress that accompanies chronic pain. Keeping culture in the conversation should remain important. It may lead to having more individuals letting their healthcare provider know that something is wrong and maybe other interventions that were not initially discussed could come into focus (Heffer & Willoughby, 2017). Reflecting upon diversity and health behaviors, resilience is defined by the individual, but their culture may distinguish how they define it, and how they respond to it whether by avoidance or seeking health. There should also be a limitation factor listed that not all health care availabilities are created equally. Even if one does need to seek help, it may be out of their

reach. This could affect their stress and pain further. Health care professionals would benefit from listening from an empathetic perspective as well.

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References Collins, F., Sorocco, K., Haala, K., Miller, B., & Lovallo, W. (2003). Stress and health. In L. M. Cohen D. E. McChargue, & F. L. Collins. The health psychology handbook: Practical issues for the behavioral medicine specialist (pp. 169-186). SAGE Publications, Inc. https://dx.doi.org/10.4135/9781412976770.n10 Heffer, T., & Willoughby, T. (2017). A count of coping strategies: A longitudinal study investigating an alternative method to understanding coping and adjustment. PloS One, 12 (10). https://10.doi:10.1371/journal.pone.0186057 Peacock, S., & Patel, S. (2008). Cultural influences on pain. Reviews in Pain, 1 (2), 6-9. https://doi:10.1177/204946370800100203 Rathi, N., Pye, M., Sin, K., Garza-Levitt, S. E., & Kamimura, A. (2021). The use of complementary and alternative medicine and pain relievers among refugees resettled in the USA. International Journal of Migration, Health and Social Care, 17 (4), 500-507. https://doi:10.1108/IJMHSC-10-2020-0092 Sharma, S., Abbott, J. H., & Jensen, M. P. (2018). Why clinicians should consider the role of culture in chronic pain. Revista Brasileira De Fisioterapia (São Carlos (São Paulo, Brazil)), 22 (5), 345-346. https://doi:10.1016/j.bjpt.2018.07.002 Yongjun, Z., Tingjie, Z., Xiaoqiu, Y., Zhiying, F., Feng, Q., Guangke, X., Jinfeng, L., Fachuan, N., Xiaohong, J., & Yanqing, L. (2020). A survey of chronic pain in China. The Libyan Journal of Medicine, 15 (1). https://doi:10.1080/19932820.2020.1730550

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