Module 4 – Part 2 – Transcultural aspects of pain perception and pain management

Often the initial reason to consult a medical doctor/ physician/ health care worker is pain. These encounters might be highly charged emotionally, because of the acute or grueling nature of the experienced pain. Language barriers, feelings of being discriminated or hopelessness might add to making situations in clinical transcultural settings challenging. In general, the perception and the expression of pain are dependent on the socialization of the patient, his or her health literacy and his or her ability to name and localize pain. Patients who grew up in a western medical system know the expectations of doctors/ physicians/ health care workers or nurses to exactly localize and describe the pain, while patients from other cultural backgrounds might not be acquainted with the same codes and rather experience and describe pain as whole-body phenomenon.

Through the expression of pain many things can be transmitted that are not necessarily organ-centered. Headache can be an idiom of distress for overload, helplessness, and perceived loss of control. Pain is also differently perceived if the cause of pain is rooted in e.g. traumatizing experiences or pain is caused by an illness. These often very complex circumstances are important for therapeutic aims and therapeutic options and need a comprehensive bio-psycho-social approach and the active involvement of the patient and his lived world.

Pain is also expressed in different socially accepted ways, which are usually determined by the pain-behavior of parents and also by the ethnic background (Boissoneault et al. 2015).

In a study on the perception of pain it was demonstrated that among Somali migrants “pain” had a much broader meaning and also included general terms like distress and illness; symptoms such as fever or allergies were described as painful experiences. Somali women had a very stoic approach towards pain expression and the tolerance for pain was described to be higher than in the native population (Finnström, Söderhamn 2005).

This does not mean that pain is objectively felt differently, it is only expressed differently. In practice it is important to recognize and judge various patterns of expressing pain to be able to assess a patient and avoid ethnic discrimination. In the USA, for example, studies have shown that even considering similar indications Afro-Americans and Hispanics are prescribed less opioid analgesic than white patients (Cintron, Morrison 2006, Goyal et al. 2015). This might be caused by a lack of transcultural competence in pain management, but is probably also a factor of racial discrimination.

Further information:

Article “Cultural Influences on Pain Perceptions and Behaviors“ [,%20pain%20perceptions%20and%20behaviors.pdf]

Presentation “Impact of Culture on Chronic Pain” []

Article „Cultural Influences on Pain Perceptions and Behaviors“ []