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Pain tolerance is called cultural

Take differences into account, nurse urges providers

Nurses and their patients don't always view pain the same way because of cultural differences. But as cultural diversity in the United States grows, health-care providers must take those differences into account in providing treatment, according to a Brigham Young University researcher.

"Nurses must be aware of cultural background to best assess and treat acute and chronic pain," said Lynn C. Callister, a BYU professor of nursing. The goal is "to provide appropriate support" for what the patient wants to do.

For 15 years she has studied women's perceptions of pain during childbirth, based on culture, interviewing women from cultures as diverse as the Middle East, China, Central America and Scandinavia. This month, the journal "Home Health Care Management and Practice" published an analysis she wrote of existing cross-cultural pain studies. It looks at various cultures' pain tolerance levels, how they perceive acute and chronic pain and attitudes toward pain during childbirth.

The Joint Commission on Accreditation of Healthcare Organizations has said assessing it should be the "fifth vital sign," along with pulse, blood pressure and other key checks, Callister said.

But it's a moving target when you're dealing with people from a variety of cultures, she noted.

Callister, who holds a doctorate degree, notes that in some cultures pain is very private, while in others it's not. For instance, in the United States people don't accept pain well and believe it should be eliminated. Mexican Americans view pain as an expected and accepted part of life. And patients in East India have a higher pain tolerance. Filipino patients may never tell you they have pain, based on their culture's stoicism.

To control pain in childbirth, 90 percent of women in the birthing centers in the United States have an epidural to control pain.

In other parts of the world, lack of medications or attitudes toward that pain explain why epidurals aren't used. In Finland, for instance, only 20 percent of women giving birth choose epidural medication, Callister said, though it is readily available.

She said that in some cultures, people who are active in a religious faith "seem to accept pain as a part of life. A lot talked about relying on a higher power for strength," she said.

But Callister pointed out that there are also different perceptions of pain and attitudes toward it within cultures, too. "You can't say all African-American women feel the same way.

"What I think is important about it is accepting and respecting how people deal with pain."

Callister said that "a nurse's evaluation of pain is different from a patient's evaluation. We're told it's important for us to believe the patient. If she says she's in pain, she's in pain."

Another problem, she noted, is that many nurses don't have linguist skills that can help cross-cultural barriers.

Much more work needs to be done in the area of culture and pain, she said.