Pain is individually and culturally subjective. Pain is each individual own physical and emotional experience. Pain is managed in different ways throughout the world. Cultural beliefs about the origin, role, and meaning of pain can affect how a patient perceives pain. Many beliefs regarding pain stem from religion and spirituality; for example, some religious groups believe pain is a part of God’s plan, a penance for sins, or a test of faith. In contrast, other cultures ascribe positive meanings to pain. These patients may view pain as a sign of progress toward recovery. The Chinese culture believes pain results from an imbalance between yin and yang, which has its roots in Taoism, Buddhism, and Confucianism (Martin & Barkley, 2016). There are also cultures who have negative attitudes toward expressing pain outwardly; for example, Black American, Hispanic American, Asian American, and American Indian patients may be reluctant to complain of pain due to strong cultural beliefs in stoicism. As a result, these patients may prefer to keep a neutral face and avoid grimacing, crying, or moaning, even if their pain is severe. Stoic pain behavior can lead to inaccurate pain assessments (Martin & Barkely, 2016).
More than 30% of Americans have some form of acute or chronic pain. Given the prevalence of chronic pain and its often disabling effects, it is not surprising that opioid analgesics are now the most commonly prescribed class of medications in the United States (Volkow & McLellen, 2016). While opioid analgesics relieve acute pain, the long-term effect and pain relief benefit for chronic pain is questionable. More than a third of the 44,000 drug-overdose deaths that were reported in 2013 were attributable to pharmaceutical opioids; heroin accounted for an additional 19%. At the same time, there has been a parallel increase in the rate of opioid addiction, affecting approximately 2.5 million adults in 2014. The major source of diverted opioids is physician prescriptions (Volkow & McLellan, 2016).
Pain in terminally ill patients, specifically pediatric patients, is the most prevalent symptom in children with cancer at the end of life, reported in 76% of children (Anghelescu, Snaman, Trujillo, Sykes, Yuan, & Baker, 2015). Pain assessment and scores in this population are an important factor in treatment and control pain. The majority of children suffering from terminal cancer use a Patient Controlled Analgesia (PCA) pump. The use of a Morphine PCA has was found to relieve the majority of pain in these patients. The use of Benzodiazepines in conjunction with the Morphine to relieve anxiety was also found to be beneficial. During the last two weeks of life, the use of the PCA and the doses of Morphine were higher than when first started on the analgesia. It is important that providers understand the high opioid requirement at the end of life in children and young adults with cancer to aid in pain releif and reduce pain and end of life anxiety (Anghelescu et al., 2015).
Anghelescu, D. L., Snaman, J. M., Trujillo, L., Sykes, A. D., Yuan, Y., & Baker, J. N. (2015). Patient-controlled analgesia at the end of life at a pediatric oncology institution. Pediatric Blood & Cancer, 62(7), 1237-1244. doi:10.1002/pbc.25493
Martin, E. M. (2016). Improving cultural competence in end-of-life pain management. Nursing, 46(1), 32-41. doi:10.1097/01.NURSE.0000475480.75266.9a
Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain — Misconceptions and mitigation strategies. Retrieved from https://www.nejm.org/doi/full/10.1056/nejmra1507771