US Pharm. 2016;41(3):2.

All of us experience pain, and we find a myriad of ways to deal with it that demonstrate individual tolerance levels, cultural tendencies, and personality. How one reacts to pain early in life, of course, also changes in adulthood.

Given my Northern European and Anglo identity, for example, dealing with pain in a stoic manner must be built into my genetic makeup. “Keep a stiff upper lip,” as they say. As a child, I remember foregoing novocaine at the dentist when having cavities filled, choosing instead to endure short-term discomfort and avoid the longer-lasting numbness—not to mention the long needle that my dentist failed to conceal from his younger patients.

However a particular culture drives a patient’s pain reaction, healthcare providers—including pharmacists—would be wise to consider these behavior patterns. As described by Donna Lisi in a feature article in this issue, “National Pain Strategy—Implications for Pharmacy Practice,’” the U.S. Department of Health and Human Services (HHS) is drafting a program to address the issue of inadequate pain management in the United States. The strategy is the result of a 2011 Institute of Medicine report calling for a cultural transformation in pain prevention, care, education, and research.

The National Pain Strategy (NPS) focuses on six pain-management areas: population research, prevention and care, disparities, service delivery and reimbursement, professional education and training, and public awareness and communication. According to Ms. Lisi, each of these key areas has direct implications for the pharmacy profession, and pharmacists will have the opportunity to play an active role in the optimal management of patients’ pain.

In the same year that HHS mandated the NPS, the organization Dimensions of Culture: Cross-Cultural Communications for Healthcare Professionals published an online report titled, “Cultural Aspects of Pain Management.” In the report, the author, Marcia Carteret, contended that while nearly all people experience pain sensations in similar ways, there are important differences in the way they express their pain and expect others to respond to their discomfort.

Patients’ culturally based responses to pain, the report finds, are often divided into two categories: stoic and emotive. Stoic patients are less expressive of their pain and tend to grin and bear it, possibly withdrawing socially (I would certainly fall into this category). Emotive patients, on the other hand, tend to voice their pain experiences and expect others to react to their pain, validating their discomfort.

The lesson for Western healthcare professionals, says Ms. Carteret, is that it is important to understand how our own culture affects our attitudes about pain. Through this filter, she says, we can effectively compare how our attitudes and beliefs are likely to collide with those of patients who come from very different cultures.

Patients with Asian backgrounds, for example, might exhibit a more reserved response to pain, stemming from their strong cultural values about self-conduct. An Asian person who complains openly about pain is considered to have poor social skills, and while this behavior might be tolerated in very small children, it is not acceptable in adolescents and adults.

In contrast, says Ms. Carteret, patients with a Hispanic, Middle Eastern, or Mediterranean heritage might favor a more intense approach, leaning toward an open expression of pain. She is careful to caution against sweeping generalizations, however, stressing that an individual’s reaction to pain is also formed by his or her personal history and “unique perceptions.”

The role of the healthcare provider, concludes Ms. Carteret, is to help patients advocate for what feels comfortable to them in the context of their culture. As the NPS mandates, the healthcare community—including pharmacists—needs to work to become more adept at evaluating pain complaints and, as a result, more effective at managing them.

Novocaine, please!