According to Shavers et al. (2010), “culturally specific attitudes and beliefs about the origin, role, and meaning of pain not only influence the manner in which individuals view and respond to their own pain but can affect how they perceive and respond to the pain of others” (p. 193). These authors outline several “dimensions” in which culture can influence pain experience: ● Individual pain-related behavior, sensations, emotions, and expectations. ● Interpersonal relationships and individual beliefs about pain and pain management (e.g., roles of family, healthcare professionals, support people). ● Intergroup relationships and the beliefs, expectations, and social meanings of pain of both the provider and the patient. ● The societal environment, which encompasses health culture, ideology, quality of life, and socioeconomics (Shavers et al., 2010). Biopsychosocial model Pain is not limited to physical symptoms. There is often an impact on the biopsychosocial components of an individual’s health and life. The biopsychosocial model of health is an interaction between the biological, psychological and social aspects of an individual. The biological elements are the body’s physical components that shape a person’s health. The psychological elements include the cognitive, emotional, motivational, attitudinal, and behavioral components that influence health. The social elements are the “actual or perceived social contacts on health” (Lehman, David, & Gruber, 2017, p. 3). Each element or component influences the overall health of a person over time. This can be seen when an individual experiences pain; the physical limitation may affect the social components of an individual’s life. Over time, the social components, together with the physical limitations, often will influence the psychological dimensions (Lehman et al., 2017). A review of the literature by Samoborec, Ruseckaite, Ayton, and Evans (2018) found that many of the factors that limit recovery were attributed to each component of this model. This study identifies biological and psychological components to be consistent factors that influence an individual’s recovery. While there is research to support certain social factors that can inhibit a person’s recovery, these factors should be addressed cautiously as there is a need for further research to support this relationship. Factors impacting recovery identified by these authors can be reviewed in Table 2.
There can also be anticipatory fear of pain – that is, thoughts or emotions that underlie an individual’s fears that engagement in certain physical activities will increase pain. These thoughts are called fear avoidance beliefs. This pain-related fear has been associated with low back pain–related disability and decreased overall physical health (Altuğ et al., 2016). Anxiety is greater when the situation is vague and when the client perceives that he or she has little control over pain. One study used functional magnetic resonance imaging (FMRI) to identify the effects of pain expectation on task performance. This method was chosen to capture the differences in blood flow in the brain while performing different tasks. The authors reported that pain expectation does change the effect pain has on task performance and the connectivity in the brain areas that process the experience of pain (Sinke, Schmidt, Forkmann, & Bingel, 2017).
Table 2: Factors Impacting Recovery Biological domain
● Pain, including the type, intensity, and duration. ● Age. ● Sex. ● Pre-accident physical or mental disability/ chronic condition. ● Pain catastrophizing and causal beliefs. ● Recovery expectations and coping skills. ● Post-traumatic stress disorder, anxiety, and depression. ● Pre-accident health-seeking behavior and somatization. ● Previous unemployment and low educational level. ● Hospitalization status. ● Procedural justice and compensation process. ● Lack of trust by insurers. ● Importance of timely healthcare decision making. ● Family and social support.
Psychological domain
Social domain (taken in context with all other factors)
Note. Adapted from Samoborec et al., 2018.
PAIN MYTHS
● Clients must say they are in pain or show physical evidence of pain before other people can believe it: False . People may not express their pain willingly or may downplay its presence for many reasons. One study found that people with osteoarthritis had difficulty expressing their pain because of the “perception that nobody wants to hear about it,” the “necessity to preserve one’s self and social image,” and “self- imposed stoicism” that caused patients to attempt to cope with the pain by not thinking about it (Cedraschi et al., 2013, p. e79988). Prkachin (2011) found that healthcare providers may underestimate pain as the result of having had “high levels of exposure to facial expressions of pain” (p. 367). ● Taking a narcotic will lead to addiction: False . A number of studies have found that when pain is relieved, the need for narcotics abates (McCaffery & Robinson, 2002; Portenoy & Dahl, 2004). According to Vowles et al. (2015), between 8% and 12% of those prescribed opiates for chronic pain develop an addiction disorder. ● If clients can sleep or be distracted by visitors, their pain cannot be very bad: False . Furthermore, the erroneous expectations of some health professionals that clients must act as if they are in pain can encourage clients to be manipulative (McCaffery & Robinson, 2002).
The following are just some of the myths that remain as barriers to effective pain management: ● Narcotics always take away the pain: False . There are great individual differences in client response to medications. There may be interference from interaction with another drug or the cognitive process involving the action of the drug, or there may be a problem with the metabolism of the drug. Some people, for example, lack the enzyme that converts codeine to morphine in the body. These clients usually excrete the medication before it can affect their pain (McGuire, 2006). ● Pain is a result of aging: False . Too often older adults endure “silently and needlessly” with chronic pain (S. T. Brown, Kirkpatrick, Swanson, & McKenzie, 2011). In addition, conditions that normally cause pain in earlier adulthood may be perceived differently by older adults. Older adults may hold the same misconceptions about pain as those held by healthcare providers. According to multiple studies reviewed by (Hallingbye, Martin, & Viscomi, 2011), “Older adults themselves may in fact believe that pain is something to be tolerated because it is an inevitable part of aging and may show increased stoicism when reporting pain” (p. 815).
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Book Code: SWUS1524B
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