Pain, psychology and culture: How our ethnic origin and culture affect perception and expression of pain

Experiments in the laboratory have shown that if you create some kind of painful stimulus, for example an electrical shock or application of freezing water, people of different ethnic backgrounds feel very different pain levels based on what their beliefs and attitudes are (Is this stimulus damaging my flesh? How do other people in the same group with me react? How quickly can they take this stimulus away?). In an earlier classic study, persons of Mediterranean origin described a form of radiant heat as “painful” while Northern European subjects called it simply “warm”. In another study, the researchers found that persons with an “external locus of control” feel a lot more pain. A person with an internal locus of control feels that life events are the result of their own actions and that they control their fate. To the contrary, a person with an external locus of control, feels that life events are outside his/her doing and depend on fate, chance or other people. Certain cultures promote external locus of control with their tight and interlinked social fabric, while typical North American culture promotes external locus of control.

Other major cultural and ethnic factors that shape our reactions to pain relate to what we perceive is a “permitted” and “appropriate” way to express pain in a given environment. Some cultures are a lot more expressive with words and gestures and at times express emotional pain in physical symptoms. Others are much more reserved in their behaviors, though they may feel the same or even more pain than the “expressive” cultures. Mind you, no matter where you come from, if your new environment is very different from your origin, and you stay in this novel environment long enough, your pain perceptions and expressions will change too. This is similar to immigrants who come to North America, change fundamentally their eating habits and acquire obesity, something unknown in their country of origin. In other words, the pain responses of different ethnic groups can change, as they are shaped and reshaped by the culture in which the groups live or move into.

A fascinating example of cultural influences in the perception and expression of pain is again reported in my book. In East Africa, some tribes use “trepanation”, a form of surgery for which the subjects do not get any anesthetics or any pain-killing drugs. Westerners have witnessed this procedure with their stomachs turning upside down, while the “patient” sits there without expression of pain, fully awake and holding a pan to collect the dripping blood from his open skull while the doktari (tribal doctor) cuts the muscles of the head and scrapes the head bones! Those of you who have read my series of previous papers on “blocking pain” must be aware by now of the fascinating aspects of some (foreign to North America) cultures that perform extraordinary rituals and procedures.

Health practiioners are bound to become more sensitive and educated about the cultural and ethnic differences in pain expression in order to serve our patients well. We must also be very aware that ethnic differences between patients and health professionals may lead to dangerous consequences. For example, different studies have shown that patients of certain ethnic (visible minority) backgrounds are less likely than whites to be prescribed powerful pain killing drugs such as opioids. Worldwide differences in administration of opioids in non-white nations are not, however, solely due to medical decision-making but may relate to politics. For example, it has been shown that the U.S. campaign against drug trafficking has resulted in poor pain management of cancer patients in Mexico.