The Intersection of Pain and Culture ____________________________________________________________
Alternative remedies for pain can be classified into five differ- ent areas, and many can be used as adjuncts to conventional therapies [121; 153]: • Alternative medications: Nonpharmacologic sub- stances, such as those associated with homeopathic medicine, traditional Chinese medicine, and Ayurveda medicine • Mind-body interventions: Interventions that focus on using the mind to influence bodily symptoms, including biofeedback, meditation, music therapy, and guided imagery. Mind-body interventions help reduce pain and improve other comorbid conditions, such as depression. • Biologically based interventions: Consumption of biologic products (e.g., herbs, vitamins, foods) • Manipulation strategies: Adjustment of focused areas of the body (e.g., chiropractic measures, massage, acupuncture) • Energy therapies: Balancing energy fields (e.g., electromagnetic therapy, reiki, qigong) Some cultural groups subscribe to the hot/cold theory of disease, which argues that illnesses are the result of bodily imbalances and that foods and alternative medications are inherently “hot” or “cold.” Pain is considered a “cold” disease, and some patients who adhere to traditional healing will take this into account when selecting and adhering to treatment approaches [142].
INTERPROFESSIONAL COLLABORATION AND PRACTICE Pain is a multidimensional problem. To facilitate greater qual- ity and more efficient care, care plans should be synchronized and carefully coordinated among the entire healthcare team. Pain is still poorly understood, and pain education has been fragmented in the different health care professions [179]. Caring for patients in pain requires a collaborative interprofes- sional team approach, with every provider contributing their unique skills, competence and roles. In addition to physicians, nurses, physiotherapists, dentists, pharmacists, occupational therapists, and mental/behavioral health professionals, alterna- tive and complementary practitioners, spiritual healers, and cultural experts all play a key role when working with diverse patients experiencing pain. The IASP has recognized the importance of interprofessional practice and learning in providing care to patients in pain. They developed an interprofessional pain curriculum that recom- mends topics and content for students in health professions in their pre-licensure programs [179]. There are four main components of the curriculum: multidimensional nature of pain; pain assessment and measurement; pain management; and pain-specific clinical conditions [179]. CONCLUSION With the expanding multicultural diversity of the United States, it is imperative that culturally competent care for pain assessment and management become the backbone in practice. In order to establish trust with patients, practitioners should be attuned to the fact that pain is a multifaceted biopsychosocial issue and the meanings of pain and suffering are embedded in a sociocultural context. As such, it is necessary to take into account the role of culture in patients’ experiences and expres- sions of pain. Culture will also influence the treatment sought, what treatment is considered acceptable, and help-seeking behaviors. This underscores the importance of being able to deliver culturally competent pain care.
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