No+pain,+no+gain?

Dylan Thomas n8301387 Tutor: Colleen

__No pain, no gain?__

//Pain is an essential factor in many cultures for traditional and religious purposes. Because of this the experiences and expression of pain across culture varies. This has a significant impact when health services deal with culturally diverse patients. //

This artefact is a heading of an article written by tattoo anthropologist Lars Krytak. It illustrates the Mentawai people from Siberut Island and their hand-tapping tattoo technique. The artefact depicts a man receiving a tattoo this way in obvious pain, and the writing around the picture perfectly sums up how painful it seems. The tattoo is performed with a ‘needle-sharp brass nail’ which does not sound pleasing one bit. Receiving tattoos is a cultural tradition for the Mentawai people and also involves significant religious meaning. Because the soul is pleased by beautiful and complete body tattoos, the Mentawai believe that it allows them to bring their material wealth into the afterlife.
 * __Artefact __**

Not only can there be a communication barrier across cultures but also the experience and expression of pain differs quite largely across cultures. This brings complications within the primary and emergency health sectors where the administration of pain relief and care of those in pain plays a large role in their jobs. Although they won’t deal with cultures as drastic as the artefact above, consideration is still needed when dealing with different cultures because there is still a large difference concerning pain. The culture of any society and the cultural concepts developed and learned over time, by its members, represents the appropriate behaviour of the people in that society. The way of perceiving, expressing, and controlling pain is one of these learned behaviours that are culture-specific.
 * __Public Health Issue __**

As racial and cultural diversity increases in countries around the world, health care workers are more and more likely to care for clients from backgrounds different from their own. This topic is very important to today’s society and specifically Australia, as Australia is a very diverse country with people from a number of cultures. The Australian Bureau of Statistics (ABS) collected data of the number of cultural and ethnic groups able to be classified in Australia this year. It was recorded that a total of 275 cultural and ethnic groups were classified. Because of this, Australian health care workers will be dealing with different cultures on a daily basis.
 * __Literature Review __**

A number of clinical studies report noticeable differences in pain perception and response across cultures. For example, Carragee, Vittum, Truong, Burton (1999, p. 97-102 ) conducted a study in two U.S hospitals comparing patients who had fixation of femoral fractures within 1 week of injury compared to a matched group of patients in three urban hospitals in Vietnam. Over a 15-day period, the Vietnamese patients were given, on average, 0.9 mg of morphine equivalent units as compared to 30.2 mg given to those in the United States. The results showed that only 8% of the Vietnamese patients reported that their pain control had been inadequate, whereas 80% of the American patients did so. Additionally, it was noted that Vietnamese patients were more likely to have an accurate impression of how much a femur fracture would hurt prior to the injury. This highlights quite a significant difference in experiencing and expressing pain across different cultures. The Vietnamese patients were given a substantially smaller dosage of morphine and were ten times as unlikely to report their pain control being inadequate. This difference can be explained through the cultural diversity between the countries. In many cultures expressing pain is seen as weak which may have been why the majority of Vietnamese patients didn’t report their pain control as being inadequate. Moreover, this indicates a significant difference in pain experience and expression across cultures. It is quite evident in this study that the Vietnamese participants expressed their treatment of pain had been adequate due to previous experiences involving pain. On the other hand, the majority of United States participants expressed their treatment of pain as being inadequate because in their culture expressing that their in pain is the norm.

Furthermore, another study conducted by Dawson & List (2009, p. 271-278) evaluated the presence of culture differences in pain thresholds and pain tolerance levels between people from Middle East and Sweden. This study found significant differences in two out of three pain tolerance level tests, but not pain threshold tests, between the Middle Eastern and Swedish cultures . This suggests that two very different cultures have dissimilar experiences and expressions concerning tolerance to pain.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;"> Additionally, Nayak, Shiflett, Eshun, Levine (2000, p. 135-151) examined the differences in pain tolerance and intensity ratings and the role beliefs play in predicting pain tolerance between college students in the United States and India. R esults displayed that college students in India were less accepting of open pain expression than those in the United States. Moreover, females were more open to pain expression than males were. Consistent with their beliefs, Indian students had higher pain tolerance levels than the students in the United States, and males had higher pain tolerance than females (Nayak e. al. 2000). This study highlights the impact of one’s culture and their pain expressions and pain tolerance levels. As shown in Carragee et al (1999) study, people from the United States are more susceptible in expressing their pain than more culturally diverse people. This idea is also supported in the results in the study where students from the United States expressed their pain more openly than Indian students.

<span style="color: black; font-family: 'Times New Roman',serif; font-size: 12pt;">These current studies basically compare groups of participants from two culturally different countries to one another. The methodologies used in these studies ranged from a survey of <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">femoral fracture patients in Carragee’s et al (1999) study, to cold pressor tests used to measure pain tolerance in both Dawson & List’s (2009) and Nayak’s (2000) study. The cold pressor test is <span style="color: black; font-family: 'Times New Roman',serif; font-size: 12pt;">performed by immersing the hand in an ice water container. A limitation apparent in all of these studies is the sample size. In <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Carragee’s et al (1999) study the participants consisted of 25 from the United States and 12 from Vietnam. Additionally, Dawson & List’s (2009) study only consisted of 32 Middle Easterners and 32 Swedes. Finally, Nayak’s (2000) study consisted of only a small total of 20 participants. Future preferences for studies in the field of culture and pain would include a larger sample to fully understand and redress the issue.

**__<span style="color: black; font-family: 'Times New Roman',serif; font-size: 12pt;">Cultural and Social Analysis __** <span style="color: black; font-family: 'Times New Roman',serif; font-size: 12pt;">Understanding that there are broad cultural, as well as individual differences in a patients pain experience can lead to more effective and sensitive care for patients and their family members.Culturally diverse patients receiving treatment in an unfamiliar and highly technologic environment with routine application of procedures and policies and unknown health care workers who most likely do not share the patient’s culture and language are at risk for increased anxiety and pain.

<span style="color: black; font-family: 'Times New Roman',serif; font-size: 12pt;">Social theorist Durkheim idea of sociology of culture suggested that culture had logical, functional and historical relationships to society. Society and culture are vital in understanding and readdressing the issue of culture and pain as they are directly related to each other. Durkheim’s concept of the logical, functional and historical relationships between society and culture highlights that one’s culture impacts on their notion of social order and beliefs. The way a person experiences and expresses pain is one of these beliefs. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">The culture of any society and the cultural concepts developed and learned over time, by its members, represents the appropriate behaviour of the people in that society. The way of perceiving, expressing, and controlling pain is one of these social learned behaviours that are culture-specific.

<span style="color: black; font-family: 'Times New Roman',serif; font-size: 12pt;">Everyone is affected by the diversity of culture and pain. If you get ill or injured in another country whose culture is quite different, you’re pain management will most likely be different to if you were at home. For example, from <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Carragee’s et al (1999) study <span style="color: black; font-family: 'Times New Roman',serif; font-size: 12pt;">, if an American was in Vietnam receiving pain management, they would receive significantly less dosages. Furthermore, the participants from the United States in this study already felt they were receiving inadequate pain treatment. If they were in Vietnam they would receive a considerably less amount.

<span style="color: black; font-family: 'Times New Roman',serif; font-size: 12pt;">Moreover, this issue is of great importance and awareness is needed on this issue, because if you work in the <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">primary and emergency health departments, dealing with different cultural cultures and pain would be on a daily basis due to cultural diversity in today’s society. Public health experts should start implementing training programs for primary and emergency health services involving cultural diversity and differences the differences with experiencing and expressing pain if they haven’t all already.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">The artefact presented above represents how different cultures experience and express pain. In western society receiving a tattoo like that is unheard of because of the amount of pain experienced by it. Although health care workers will not be dealing with patients as culturally diverse as depicted in the artefact, it is just an example of how a different culture experience’s and express’ pain. To me, the artefact displays the lengths one goes to for his or her own culture. Receiving tattoo’s for the Mentawai people is a very cultural and religious experience which outweighs the pain. It is vital for them in attaining their religious beliefs, particularly involving death. This has taught me to be more culturally aware of people around me. Especially when I’m working in health services in the years to come, I will be more conscious when dealing with culturally diverse patients specifically with pain management and pain control. I will take into account how different cultures display different experiences and expressions with pain.
 * __<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Artefact analysis and Learning Reflections __**

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Australian Bureau of Statistics. (2011). 1249.0 - Australian Standard Classification of Cultural and Ethnic Groups (ASCCEG). Retrieved 20th October, 2011, <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/1249.0main+features22011
 * __<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">References __**

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;"> Carrage e, J ., Vittum, D ., Truong T., Burton D. (1999). Pain control and cultural norms and expectations after closed femoral shaft fractures. //American Journal of Orthopedics//, 28(2), 97-102. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Dawson, A., & List, T. (2009). Comparison of pain thresholds and pain tolerance levels between Middle Easterners and Swedes and between genders. //Journal of Oral Rehabilitation//. 36(4), 271-8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed = = <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;"> Eshun, S. (2000). Culture and gender effects in pain beliefs and the prediction of pain tolerance. // Cross-cultural research //, 34 (2), 135-151. doi: 10.1177/1069397100 03400203 = = <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Krutak, L. (2011). //Titi: Spirit Tattoos of the Mentawai Shaman//. Retrieved October 30th, 2011, from http://www.larskrutak.com/articles/Mentawai/index.html

<span style="color: black; font-family: 'Times New Roman',serif; font-size: 12pt;">Van Krieken, R, Habibis, D, Smith, P, Hutchins, B, Haralambos, M & Holborn, M. (2010). //Sociology: Themes and Perspectives,//4th edition, Pearson Education, NSW.


 * __<span style="color: black; font-family: 'Times New Roman',serif; font-size: 12pt;">Reflective Comments __**


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