Posted by Suzanne Salimbene.

• Do all people feel pain to the same degree?
• If so, why are some people more tolerant of pain than others?
• Is the way pain is expressed and the ability to tolerate pain a matter of individual differences, or are the differences culturally conditioned?

The use case:Let’s examine at a glance, for example, the behavior of four women in the labor-and-delivery room of a hospital in a diverse city. Each woman is experiencing pain although the expression of that pain varies widely. This use case is necessarily brief. In my textbook What Language Does Your Patient Hurt In 3e, you will find additional background information and deeper cultural context for the behaviors encapsulated here: A Mexican woman is clutching the hand of a nurse and shouting, “My God, my God, it hurts so bad! I can’t stand the pain!” A Chinese woman across the ward lies quietly—stoically bearing her pain—while the Russian woman next to her is threatening to report the nurses to the authorities if she is not given something stronger to reduce her pain. Meanwhile, an Ethiopian woman in the same ward is demanding to see a doctor, but then yells, “Don’t you touch me!” when he arrives and wishes to examine her.The findings:Do these women actually experience different degrees of pain? Is their tolerance of that pain influenced by culture? Studies of the relationship between culture and pain have indicated that both the experience of pain and the readiness to complain about pain vary greatly with culture. People who belong to cultures where the expression of pain is rewarded with sympathy, attention, and comforting behavior tend to express pain more readily than those who come from cultures that perceive of pain as an inevitable part of the human experience or as a punishment for past sins. Those who come from cultures that frown upon the open expression of feelings and emotions also tend to mask their pain. By the same token, studies of caregivers’ responses to their patients’ expressions of pain indicate a strong influence of cultural programming. One study of more than 4,000 nurses in 13 countries showed that the healthcare professionals inferred a greater degree of psychological anguish than physical suffering from their patients’ expressions of pain. Jewish and Hispanic patients were seen as suffering the most, while Asian and Anglo-Saxon/German patients were seen as suffering the least. Those nurses with northern European backgrounds—especially those from England and Belgium—and those with North American backgrounds inferred the lowest degrees of patient suffering, while those with African, southern European, and eastern European backgrounds inferred the highest degrees of patient suffering. These findings have important implications in today’s diverse healthcare environment. If a nurse or physician from North America, for example, is caring for a patient from another culture and infers that the patient is experiencing less pain or distress than she expresses, it is likely that the patient would be labeled as a complainer and the healthcare professional would administer less pain medication to her. That patient would probably feel that care is not only unsympathetic but inadequate. On the other hand, a caregiver from a culture in which pain is openly expressed may make a patient from a northern European background feel overly anxious by what the patient sees as an exaggerated sense of caregiver concern.Your considerations:How is pain expressed in your culture?

• If it is openly expressed, how might that influence your reaction to a patient who denies the feeling of pain or stoically accepts it and refuses pain medication?
• If you come from a culture in which pain is expected to be quietly accepted, how do (or would) you respond to a patient who openly expresses it?

What might you do to block your own cultural programming and explore each individual patient’s level of pain?Suzanne Salimbene, MS, PhD, is the author of What Language Does Your Patient Hurt In? Third Edition. For more than 40 years, she has been writing, speaking, and teaching on various topics that involve both English as a second language and meeting the needs and expectations of culturally and linguistically diverse patient populations. - See more at: http://blog.paradigm.emcp.com/the-cultural-factor-in-pain-and-pain-manag...