Introduction     Culture is the framework that directs human behavior in a given situation. The meaning and expression of pain are influenced by people’s cultural background. Pain is not just a physiologic response to tissue damage but also includes emotional and behavioral responses based on an individual’s past experiences and perceptions of pain. Not everyone in every culture conforms to a set of expected behaviors or beliefs, so cultural stereotyping (assuming a person will be stoic or very expressive about pain) can lead to inadequate assessment and treatment of pain. Many studies have shown that patients from minority groups and cultures different from that of health care professionals treating them receive inadequate pain management.

‘Cultural Competence’      Health care professionals need to be aware of their own values and perceptions as they affect how they evaluate the patient’s response to pain and ultimately how pain is treated. Even subtle cultural and individual differences, particularly in nonverbal, spoken, and written language between health care providers and patients impact care.

To be culturally competent, you must:

• Be aware of your own cultural and family values
• Be aware of your personal biases and assumptions about people with different values than yours
• Be aware and accept cultural differences between yourself and individual patients
• Understand the dynamics of the difference
• Adapt to, and respect, diversity

You must Listen with empathy to the patient’s perception of their pain, Explain your perception of the pain problem, Acknowledge the differences and similarities in perceptions, Recommend treatment, and Negotiate agreement.

Questions that staff can use to help assess cultural differences in order to better assess and work out an appropriate pain management plan with a patient and family include:

• What do you call your pain? Do you have a name for it?
• What do you think caused your [pain]?
• Why do you think it started when it did?
• What does your [pain] do to you?
• How does it work?
• How severe is your pain? Will it have a long or short course?
• What are the most important results you hope to receive from the treatment?
• What are the main problems your [pain] has caused you?
• What do you fear most about your [pain]?

See Fast Facts #17, 216 for further discussions about assessing cultural and individual understanding of illness.

This Fast Fact was adapted with permission from the University of Wisconsin Hospital & Clinics, Madison, WI Pain Patient Care Team ‘Pain Management Fast Facts – 5 Minute Inservice’ series.

References

1. Anderson KO, et al. Pain education for underserved minority cancer patients: a randomized controlled trial. J Clin Oncol. 2004; 22(24):4918-4925.
2. Davidhizar R, Giger JN. A review of the literature on care of clients in pain who are culturally diverse. Intl Nurs Review. 2004; 51(1):47-55.
3. Bates MS, Rankin-Hill L, Sanchez-Ayendez M. The effects of the cultural context of health care on treatment of and response to chronic pain and illness. Soc Sci Med. 1997; 45(9):1433-1447.
4. Kleinman A, Eisenberg L, Good B. Culture, illness, and care. Clinical lesions from anthropologic and cross-cultural research. Ann Int Med. 1978; 88:251-8.

Version History:  This Fast Fact was originally edited by David E Weissman MD. 2nd Edition published July 2006; 3rd Edition June 2015. Current version re-copy-edited April 2009; then again June 2015. Arthur Kleinman reference added March 2013.