Cultural Differences in Chronic Pain: A Brief Review

Abstract

Chronic pain experience is influenced by cultural beliefs and traditions among different groups. Risk factors for the development of chronic pain are consistent across cultures; however, there are vast differences in the perception, expression, coping, and management of pain. The aim of the present review was to compare cultural variations in chronic pain experience, pain management, and the relative effectiveness of opioid treatment in pain control among various cultures. Methods: A literature search was conducted in PubMed, MEDLINE, EMBASE, and Google Scholar, using combinations of the following key words: "chronic pain," "prevalence," "culture," "management," and "developing countries." The analysis of the literature focused on cultural differences in chronic pain experience, perception, and management. The studies that met the inclusion criteria were organized into separate groups for cultural variations in the experience of pain, chronic pain management, and opioid treatment. Results: Various factors affect the human pain experience, including social norms and biological traits. Within the United States, African Americans and Hispanics have reported higher pain scores when compared to Whites and Asians. American Indians and Asians have stated the least pain complaints among all groups. Countries outside the U.S. have also reported differences in chronic pain across ethnic groups. Some cultures present highly expressive pain experiences, while others exhibit stoicism. Chronic pain patients in most of the world rely on NSAIDs, massage therapy, physical therapy, and traditional medicine for treatment. In the United States, opioids are the main treatment for chronic pain, although their use has not shown more effectiveness in controlling pain symptoms than other types of analgesics or non-pharmacological therapy. Conclusion: The impact of culture in pain experience is displayed by a variety of patient attitudes, behaviors, beliefs, and coping mechanisms. Pain management approaches are likely based on cultural beliefs about health that influence expectations regarding treatment outcomes. Opioid pain management, despite its rampant use in the developed regions of the world, has not been proven to be a superior alternative, except in countries that commonly use traditional medicine and turn to opioids only when all other pain treatments have failed.Pain is a universally unpleasant experience comprised of emotional and sensory components that can be triggered by tissue damage, and may persist after healing. 1 Generally speaking, when pain manifests for 6 months or longer, and has been experienced within the last month, that pain is considered chronic. 2 Despite global variation in cultural characteristics and development level, several risk factors have consistently been associated with the development of chronic pain: female gender, older age, lack of education, lower socioeconomic status, employment status, and obesity. [2][3][4][5] Multiple studies have reported that the