Influence of culture on pain perception in patients with chronic pain: a review

Abstract

Chronic pain is a universal experience that can be explained using physiological, psychological, socio-cultural and spiritual aspects. The culture would largely influence one's pain perception. Hence, health professionals have to be cognizant of meeting the needs of culturally diverse patient populations when developing psychological interventions for chronic pain. The objective of this paper is to review current evidence of cultural influence on pain perception of patients with chronic pain. The five-step review guidelines: (1) framing a question, (2) identifying relevant work, (3) assessing the quality of studies, (4) summarising the evidence and (5) interpreting the findings were used. The literature search was performed using databases: PubMed, Scopus, PsycINFO and MEDLINE. The search was performed with the keywords "chronic pain", "cultural influence", and "pain perception" combined by Boolean operators OR/AND (culture AND pain perception), (chronic pain AND culture) and (cultural sensitivity OR cultural difference). A total of 75 studies published between 2000 to 2020 were identified. Fourteen studies were included in the analysis. Studies involving adult patients (≥ 18 years old) with persisting pain for more than three months measured on a Visual Analogue Scale (≥ 40 on a 100 mm scale) were included. Full-text articles published other than in the English language were excluded. The studies related to acute pain, oncological pain and nonpeer-reviewed articles were excluded. The analysis of research findings yielded three main themes (1) pain expressiveness versus stoicism, (2) the propensity for using traditional remedies and prayers, and (3) language and literacy. It can be concluded that there is evidence regarding the differences in pain perception among different races, ethnicities and cultures. Hence, developing socio-culturally sensitive psychological interventions is crucial to reduce the cultural disparities in the treatment of chronic pain. The study limitations might be the use of different measurement tools of pain perception, the comparisons of various populations and the inconsistent control for confounding variables. A clinical implication of the review is to enhance clinicians' cultural awareness and encourage them to develop socio-culturally applicable interventions.