“Pain is a highly complex phenomenon that involves biological, psychological and social variables.” (Carterett, 2010, p.1) An increasing cultural diversity in our country means that health care providers must offer culturally relevant treatment and care on a daily basis. Although race, ethnicity and culture or often used interchangeably, they actually represent very different concepts.
Race as a construct identifies people according to their ancestry, a genetic heritage.
Ethnicity refers not only to biological and physical characteristics but also include culture and behavior.
Culture can be defined as a coherent set of values, beliefs and concepts, or a set of learned attitudes or ideals that mold the behavior of a population or particular society.
Anorexia Nervosais an eating disorder that affects approximately 0.2-1.3% of the population; that’s about 5 to 10 cases per 100,000 people. There is a 9:1 ratio of female to males that have anorexia nervosa; it does affect males as well! About 0.5-1% of women between the ages of 15 and 30 have anorexia. Age 17 is the median age for people who suffer from this.
Anorexia nervosa is a psychiatric disorder that’s characterized by abnormal eating behavior and severe self-induced weight loss (Ferri, 2018). These patients have an intense fear of gaining weight. There are two types of anorexia which include the restricting type that restricts all fat and food intake and the binge-eating / purging type that includes binge eating followed by vomiting with abuse of laxatives.
Depression is a mental disorder that affects the emotion, cognition, behavior, and physically. Thus, it interferes with the daily life of the patient. One out of 10 adults experience one or more episodes during their lifetime. Common complaints presented to the office are lack of interest in pleasurable activities, insomnia, digestive problems, and unexplained chronic aches and pains. As there are many forms of depression, treatment varies depending on the specific diagnosis. Types of depression may include: major depression, single versus recurrent episode (mild, moderate and severe with or without psychotic features); persistent depressive disorder (dysthymia), postpartum depression, seasonal affective disorder (SAD), bipolar disorder, and premenstrual dysphoric disorder. Most depression is associated with other physical or mental disorders (Cash & Glass, 2017). Although this condition is prevalent in primary care patients, few patients admit to being depressed and present with somatic symptoms such as headaches, back problems, or chronic pain making detection of depression more difficult to diagnose (Williams & Nieuwsma, 2018). This make it imperative that providers must learn to inquire sensitively about depression and how to utilize evidence-based screening tools available.
Attention deficit hyperactivity disorder (ADHD) is a chronic disorder of attention and/or hyperactivity-impulsivity that is typically diagnosed in children 6 to 9 years of age (Katz, 2018). Approximately, 5 to 10 % of school aged children, primarily males, have ADHD (Katz, 2018). Two to 5 percent of adults have ADHD (Katz, 2018). In the adult population the number, or ratio, of females diagnosed with ADHD is equal to males (Katz, 2018).
“Currently, there is no known neurophysiological or neurochemical basis for the disorder. Imbalances among levels of norepinephrine, dopamine, and epinephrine all seem to be involved” (Dunphy, Winland-Brown, Porter, & Thomas, 2015, p. 1108). Family history, genetics, provides the strongest evidence for etiology of ADHD (Katz, 2018). Having a first-degree relative with ADHD makes an individual 5 times more likely to have ADHD (Katz, 2018). Many times ADHD goes unrecognized throughout childhood, or people with ADHD were able to compensate for their symptoms when they were young, but as their responsibilities increase their symptoms become more apparent, negatively impacting them both professionally and their personal relationships (Smith & Segal, 2017). Unlike children with ADHD, adults with ADHD typically do not have motoric hyperactivity (Katz, 2018). Adults commonly present with complaints of restlessness, edginess, difficulty relaxing, disorganization, boredom, difficulty paying attention or focusing, and difficulty completing tasks (Katz, 2018). Frustration with job and life routines are also common complaints among adults with ADHD (Dunphy et al., 2015).
Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you’re sitting or lying down. Moving eases the unpleasant feeling temporarily. Restless leg syndrome is a common neurological sensorimotor disorder with an overall prevalence in adults of 5-10% in Europe and North America. Restless legs syndrome had a higher prevalence in men than women, with the difference reaching significance in those 40-49 years old; in men there was no positive correlation with age. Can begin at any age and generally worsens as you age (Chatterjee, Mitra, Guha & Chakraborty, 2015).
Restless leg syndrome is manifested by strong feelings of restlessness and distressing paraesthesia-like sensations (crawling, burning itching and tingling) in the lower legs, particularly when at rest. As a result of that, patients usually have a difficult time to maintain a proper sleep pattern; the symptoms vary considerably in severity and frequency (Borreguero & Pumarega, 2017). It can disrupt sleep, which interferes with daily activities.