____________________________________________________________ The Intersection of Pain and Culture
both pain intensity and quality [100; 103]. There are a set of descriptors for each of the three dimensions, and the original long form takes 10 to 15 minutes to administer and assesses nearly 100 dimensions of pain. However, a shortened version of the form consisting of 15 sensory and affective descriptors and a verbal rating of the pain’s level and duration takes only 2 to 5 minutes to administer [100; 104]. Although it is not a substitute for the long-form version, the shorter instrument is reliable when limited time is available [104]. The Brief Pain Inventory measures a patient’s pain intensity in terms of sensory pain experienced and interference with life. It also assesses pain relief, pain quality, and patient views about the causes of the pain [105]. The Brief Pain Inventory is comprised of 32 items, with the patient selecting his or her responses on a scale of 0 to 10. The original long-form version takes about 15 minutes to administer [105]. The short form is similar and inquires about pain intensity and pain interfer- ence using a rating scale and the percentage of pain relief by analgesics [105]. Closed-Ended Pain Assessment Scales and Culture It is important to consider if instruments that have originally been developed for and targeted to White patients will be culturally appropriate for use with racial and ethnic minorities. As discussed throughout this course, pain is highly subjective and is influenced by language and culture. Taking this into consideration, many of the closed-ended item question pain rating scales have been adapted for cultural and racial/ethnic minority groups. The numerical rating scale was translated (and back-translated) into Swahili for use in Kenya and pilot tested with 15 individu- als 8 to 69 years of age. In general, the participants understood what the progression of the numbers conveyed and thought the scale was easy to understand, with good face validity [106]. However, some studies have shown that linear numerical scales are conceptualized differently based on a group’s cultural norms. For example, one study found that Native American patients selected a number on the rating scale not to reflect their pain but because it had symbolic and sacred connota- tions to them [93; 107]. Language is another consideration. The number four is nearly homophonous with the Mandarin word for “death,” and therefore, some Chinese patients will be less likely to select this number on the pain rating scale. The visual analogue scale is typically presented on a horizontal scale, which can present problems in come cultural groups. For example, because some traditional Asian languages are read down vertically, unlike European languages, which are read horizontally left to right, respondents in one study could not comprehend the visual analogue [108]. As such, modification of the scale may be necessary for these populations.
The revised Iowa Pain Thermometer (IPT-r) and the revised Faces Pain Scale have also been demonstrated to be valid and reliable for older African Americans [16]. Both instruments are pictorial (i.e., a thermometer and a set of faces). Older African American adults tend to prefer the verbal descriptor rating scale, which is generally valid and reliable for this population [16]. Furthermore, it has also been adapted for use with racial and ethnic minority groups. Translation of the verbal descriptors into Chinese and translation back into English resulted in the following terms, from most to least painful [108]: • Crucifying pain • Crushing the heart and lungs • Excruciating pain • Unbearable
• Indescribable • Very painful • Painful • Bearable • Quite painful • Slight pain • No pain
The McGill Pain Questionnaire has been translated into 26 different languages including Chinese, Korean, Spanish, Ital- ian, German, Turkish, Japanese, Dutch, German, Greek, and Norwegian, and it has been validated among various cultural groups [109; 110; 111]. One study found that the term “pain” was used to describe severe intensity versus terms like “ache” and “hurt” for less intense pain [53]. This trend was observed among Hispanics, Native Americans, African Americans, and non-Hispanic White Americans. In another study using medical records of 268 Hispanic and non-Hispanic White patients, the McGill Pain Questionnaire was equally reliable for both groups [112]. However, there were statistically significant differences in the five descriptor items (i.e., throbbing, gnawing, aching, tiring- exhausting, and sickening). The Brief Pain Inventory has also been adapted for use with other groups. Not only has it been translated into and validated for several languages (e.g., Chinese, Japanese, Korean, Malay, Thai, Taiwanese, Norwegian, Spanish, Russian, Italian, Greek, Portuguese, Hindi, Polish), it has been found to be valid and reliable for many groups [113]. For example, in a study of 534 Taiwanese patients with cancer, the researchers found the Taiwanese version was reliable for both pain intensity and inter- ference scales [114]. A study with 143 Brazilian patients from outpatient cancer clinics showed good validity and reliability with the Portuguese version [115]. Analyses also demonstrated good correlation with the McGill Pain Questionnaire [115].
68
MDIL1526
Powered by FlippingBook