The assessment and treatment of pain in primary care is challenging at best. The most common pain complaint is back and neck pain, causing disability and reduction of quality of life (Moi et al. 2018).  The evaluation of pain can be made even more difficult when age and cultural differences are considered.  As an emergency department providing care for patients in 22 nursing homes within a 5-mile radius, we see many non-verbal and/or patients with communication challenges.  While we employ a numerical scale of 1-10, this is rendered worthless with patients that cannot understand the premise or cannot verbalize their answer.  For our pediatric population we utilize the FLACC scale and for those adults with communication challenges utilize the FACES scale.  While either are not the most accurate scales, they do allow healthcare providers to address pain.

Cultural differences are not only within the realm of race.  Different geographic area of the country has different cultures.  The age of someone means a different culture.  For our elderly patients, many grew up during the depression, or were raised by parents of the depression.  This demographic tends to view healthcare providers with reverence, never questioning what a provider tells them.  As such, they are reluctant to tell a provider that they are experiencing pain, for fear of being bothersome.  With the younger generations having the ability and access to information, they present with preconceived notions and a plan of care.  Ethnicity is another cultural difference.  With the United States having a Hispanic population of 54 million, this is a large demographic (Schembri and Ghaddar, 2017).  To further complicate this is the fact that the Hispanic population is not solely from one country or geographic region.  The three most common sub-groups residing the United States are those from Mexico, Puerto Rico (although U.S. citizens) and Cuba (Schembr and Ghaddar, 2017).  This does not include that demographic from Central or South America. 

References

 

Moi, J. Phan, U. de Grucky, A. Lew, D. Yuen, T. (2018) Is establishing a specialist back pain

            Assessment and management service in primary care a safe and effective

            Model? Twelve-month results from the back pain assessment clinic (BAC)

            Prospective cohort pilot study. BMJ Open 8(10)

Schumbre, S. Ghaddar, S. (2017). A cultural view on healthcare access: considering the

            Hispanic perspective. Advances in Consumer Research.  Vol 45

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In reply to James Rhinehart

Re: d8

by Dona Clarin – 
Well done. Describe a health practice that may be different in different cultures.

13 words

In reply to Dona Clarin

Re: d8

by James Rhinehart – 
There are many alternatives to the treatment of pain. These can range from exercise, simple rest and acupuncture. While rest and exercise are more Western culture centered, acupuncture is based on Eastern medicine. Acupuncture has been practiced in China for more than 3000 years (Zuang et al. 2013). Acupuncture was first utilized to decrease dental pain (Kelly and Willis, 2019). When this proved to be effective, the medical community became interested and began studies on the efficacy of the use of acupuncture. Utilizing magnetic resonance imaging brain function was studied (Kelly and Willis, 2019). The practice of acupuncture involves the insertion of small needles into the skin to reduce pain, anxiety and tension (Patil et al. 2016). Eastern medicine believes that pain, anxiety and tension are caused by an imbalance in the energy pathways. By using acupuncture, these pathways, called qi or meridians, are restored to proper functioning (Patil et al. 2016: Kelly and Willis, 2019). By keeping an open mind concerning patient treatment, a healthcare provider could help patients return to a higher quality of life.
References
Patil, S. Sen, S, Bral, M. Reddy, S. Bradley, K. Cornett, E. Fox, C. Kaye, A. (2016). The role of acupuncture in pain management. Current Pain and Headache Reports. 4(20)
doi: 10.1007/s11916-016-0552-1.
Kelly, R. Willis, J. (2019). Acupuncture for Pain. American Family Physician. 100(2) p 89-96
Zhuang, Y. Xing J. Li, J. Zeng, B. Liang, F. (2013). History of acupuncture research. International Review of Neurobiology. doi: 10.1016/B978-0-12-411545-3.00001-8

249 words American Sentinel N522PE Module 8 – Pain Assessment & Cultural Competency