Many things contribute to how we experience and express pain. Gender, age, education, socioeconomic status, the relative power of the participants in the conversation, and whether the person in pain is speaking in their mother tongue or another language all affect a person’s experience of pain.
Each of these factors can have a crucial impact on how we communicate about pain, and how we understand pain communication from others. These issues have begun to attract the attention of researchers, but are far from well understood, even in English. And all of these factors only make full sense when understood in the context of the culture in which they are embedded.
Culture and pain
Culture relates directly to the expression of pain. Our upbringing and social values influence how we express pain and its nature, intensity and duration. These factors are not as obvious as socio-psychological values such as age and gender.
Some cultures encourage the expression of pain, especially in the southern Mediterranean and Middle East. Others suppress it, as in the many lessons to our children about behaving bravely and not crying.
Some cultures show what is, to us, an almost super-human tolerance of pain, like the English author Fanny Burney, who in 1808 offered to hold her own cancerous breast while the surgeon removed it without anaesthetic. Such were the cultural expectations of people of her class at that time. And of men generally, especially in military service, who were expected to undergo treatment stoically and without painkillers.
In contrast, in the 21st century we are accustomed to expect that pain can and will be blocked or removed.
In contemporary Anglo-European cultures we tend to express pain, to “get it out” by sharing it with others. Confucian cultures, which cover much of Southeast Asia, tend to advocate that people should keep their pain to themselves.
In cultures with a great difference of power between the powerful and the powerless, doctors are revered as holders of wisdom. It is inappropriate to ask questions of the doctor, who is expected to know about symptoms and diagnosis, including the nature and extent of a patient’s pain, and what to do about it. This was typical of Western medicine until a generation or so ago, and is common in Southeast Asia.
Changing ideas of pain
Cultures can change over time. Until about the 18th century, Christian cultures in Western Europe had a broadly fatalistic view of pain. Genesis (3:16) tells us that
in sorrow [i.e. pain] thou shalt bring forth children.
Pain was heaven-sent, a concomitant of the human condition:
[a] necessary trial, unpleasantness preceding some greater good, punishment, or fate.
The pain of the human life would be assuaged after resurrection.
But over the following centuries pain was progressively medicalised. Research into physiology in the 17th and 18th centuries demystified pain and made it accessible to human intervention. The discovery of anaesthetics and analgesics in the 19th century then made possible the discretionary use of pain mitigation by doctors.
As a result the relation of pain to cultural values and expectations underwent a radical change: pain was subject to human intervention and treatment.
In Western societies we now believe our medical conditions can be treated and controlled. We expect our doctors and pharmacists to be able to do just that, and on demand.
But attitudes to taking pain medication differ widely. Some individuals typically avoid pain medicines unless they are in severe pain. Others have recourse to common over-the-counter pain medicines. Still others become addicted to opioids, the most powerful medicines for pain control.
In some societies, Western medicines are trusted for radical intervention, while traditional or homeland treatments are used for longer-term treatment. There is also evidence that ethnic background can affect the nature of health care offered to patients, including pain relief.
We are also starting to learn the substantial role the brain takes in either reducing or augmenting the pain experience.
Pain is recognised as part of the human experience. So we tend to assume that communicating about pain will seamlessly cross cultural boundaries. But people in pain are subject to the ways their cultures have trained them to experience and express pain.
Both people in pain and healthcare professionals experience problems communicating pain across cultural boundaries. In a matter like pain, where effective communication can have far-reaching consequences for medical care, quality of life and possibly survival, the role of culture in pain communication remains under-evaluated.
This article is part of a series focusing on Pain. Read other articles in the series here.