Pain: Cultural, Judgmental, Manageable

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The recognition and treatment of pain is an important part of cancer management. Yet pain is a more complex entity than we might think.

The neurological and chemical signals that damaged tissues send to the nervous system are basically the same in everyone. However, the interpretation of what those signals mean is quite variable.

When pain strikes, it is accompanied by activity in every part of the body, including multiple areas of the brain. In addition, it is usually associated with some sort of unpleasant emotion. We all experience pain differently, in quality and in severity.

Harry Gibbs, M.D., associate professor and MD Anderson's chief diversity officer, shares recent research on this subject.

By Harry Gibbs, M.D.

Pain is cultural
There is some evidence to support biological differences in the sensation of pain among certain ethnic groups. However, the bulk of our reaction is learned behavior that is partially shaped by our culture.

A study conducted in Ontario demonstrated a difference in pain sensitivity between Canadian-born Chinese individuals and Chinese immigrants to Canada. These differences were attributed to a greater familiarity with Western medical procedures among those born in North America.

Other studies have found that African-Americans with prostate cancer report more severe pain when compared with white men. "Non-traditional" forms of pain management, such as acupuncture, have been shown to be more effective in patients from Eastern cultures than from Western ones.

Pain is judgmental
To deliver appropriate symptom relief, health care providers must frequently determine the presence and severity of pain in patients. Like all other assessments, this judgment is affected by experiences and cultural biases.

Historically, providers frequently diminished pain severity in ethnic minority patients and prescribed inadequate doses of analgesics. Reasons for this ranged from a sense that the patient was "hysterical" or was faking the pain, to a fear of creating or enabling a "drug addict" by giving narcotics.

Language barriers have also been sited as possible cause for misinterpretation, although a recent study showed little difference in the effectiveness of pain assessment tools when they were properly translated for patients who did not speak English.

Pain is manageable
Pain control cannot be measured by instruments. It is determined almost exclusively by asking patients how they feel. Therefore, cultural and linguistic approaches to pain management need to be developed so that patients can fully describe their pain and the impact of therapies.

In addition, a more holistic approach to pain, which includes not only the biological but also the personal, cultural and psychological determinants of pain sensation, will result in more effective diagnosis and management.

MD Anderson resources:

Office of Institutional Diversity

Getting to know Harry Gibbs, M.D.

Pain Management Center

Patient Education: Pain Management

Cancer Pain (audio webcast with Allen Burton, M.D.)

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