Culture, Health, & Pain

     I am enlightened by the assumption that pain is a universal experience, as well as an inner experience, which means although all people experience pain similarly, there are differences in people’s perception of pain and expectation of how others respond to their pain. That is because pain is not only understood in biological aspect but also it is sensitive, emotional, and cognitive (Kleinman et al., 1992). Biological, psychological, and social factors intertwine in the response, expression and management of pain. It reminds me the influence of culture on pain experience.

     Culture difference in pain-related behavior, I think, is likely to derive from social contexts, since the way that an individual interpret and understand pain depends on his or her past experience. The relation between pain and culture combines science and philosophy together. Pain is defined differently using their own languages and idioms in various cultural groups. For example, to patients from Asian cultures, they are often stoic facing pain. Why people in Asian cultures have high pain tolerance? It is probably linked to cultural beliefs of self-management. Even though an individual feels pain, it is a habit to make it unobvious and hide it. Asian patients view it as an improper social manner to complain pain openly. I think this cultural value arises from traditional Asian cultures which assert that harmony in interpersonal communication is important.

     Undoubtedly, it is essential to deliver culturally competent care. However, how do clinicians measure patients’ pain, in order to conduct appropriate health care? What about self-report? But different words are used to describe pain in different culture, and many of them are too abstract to understand. Language is limited in conveying pain experience. And how do clinicians understand patients’ narratives about personal pain experience? There is neither easy way, nor assured way, I am afraid. In addition, it is not necessarily true that everyone from a culture will perform the “typical” or expected behavior in this culture when suffering pain. Thus developing a critical reflexive awareness is needed in health care. Still, we should keep in mind that culture is a framework that directs patients’ behavior. An individual’s experience of pain may rely on his or her cultural belief, past experience, and unique characteristics. Every patient is a unique unity. By careful listening and probing each patient’s feeling and experience, health care providers may discover what is happening.

     In many cultures, interestingly, people often believe illness and pain are caused by evil spirit or punishment from a higher power such as God. In this case, patients might refuse pain medication because they think it is God’s desire and God will help him to bear it. Additionally, it is a common saying in Chinese culture, that as long as you can suffer the pain that you encounter, you will obtain spiritual growth. Hence for health care professionals it may be not wise to judge their beliefs. Conversely, they need to anticipate patients’ needs and values, and initiate conversation with patients, to negotiate an appropriate treatment for patients within their cultural and religions contexts. Never take for granted, and be rigorous when exploring deeper origins.