The Perception And Expression of Pain Through A Cultural Lens

Culture is the set of deeply ingrained shared beliefs, values, customs, and behaviours that define a group of individuals. Cultures also shape how people interpret, perceive, and experience pain. 

Even though pain is a universally experienced phenomenon, its interpretation is highly subjective across cultures and societies and unique to the person experiencing it (Callister, 2003). Different cultures have different ways of expressing and coping with pain. Pain perception, communication of pain, and behaviours associated with pain are highly influenced by the socio-cultural context of the people experiencing the pain (Callister, 2003). While some cultures accept open expression of pain and discomfort, others believe in showing emotional resilience and endurance (Gatchel et al., 2007). Latin or Mediterranean cultures might express and communicate pain more openly, whereas collectivist cultures in Asian countries might be more stoic towards pain, which can also increase pain thresholds (Zborowski, 1952). Such variations encourage healthcare professionals to adopt more culturally sensitive pain perception and assessment approaches.

Culture and Pain Perception

Shaped by historical contexts, mainly colonialism, the perception and expression of pain have differed between the Eastern and Western worlds. Colonialism has influenced the nation's socio-cultural context, especially in the East. The Western world views pain as an individual experience, while emotional and psychological pain in the East is viewed through a collective lens where suffering is shared with the cultural group. It is largely shaped by violent colonial histories where individuals experience collective trauma due to oppression and displacement (Kakar, 2022). Another research suggests that higher pain tolerance in the East and African countries is due to colonialism by the West; being exposed to violence through war, conflicts, or trauma may improve pain tolerance as individuals adjust to stressful and painful conditions (Fanon, 2004). Due to violence and wars, individuals may experience an increase in their pain threshold as a result of repeated exposure to pain and suffering. This phenomenon is attributed to emotional desensitisation, cultural conditioning, and psychological adaptation. Research indicates that continued exposure to pain, whether through personal experiences or observing others, can lead to enhanced pain tolerance and threshold due to neuroplasticity and changes in neural responses (Baliki et al., 2008). Additionally, Gatchel et al. (2007) observed that individuals exposed to chronic pain or stress may mentally block out and endure the stressful stimuli as a result of prolonged exposure.

Recently, there has been more focus on open emotional expression of pain in Western countries than in the East, where expressing pain is discouraged. The emphasis on discussing feelings of pain openly as part of the therapeutic process is widely practised in the West. This is largely driven by the growth of psychotherapy and pain management techniques that encourage people to verbalise their suffering as a means of emotional healing. In Western medical practice, this has been prevalent, as expressing pain is essential to diagnosing and treating it effectively (Bendelow & Williams, 1995) in contrast to the Eastern cultures, where outward displays of pain are often discouraged due to the influence of Buddhist and Confucian ideals of stoicism and emotional restraint discouraging the overt expression of pain (Okolo et al., 2024). The expression of pain and suffering is seen as a disruption to social harmony and is even viewed as a sign of weakness (Zborowski, 1952). Psychological and mental health issues remain taboo in India, with those struggling often viewed as weak. This stigma leads to social isolation, further increasing their suffering. In cultures such as Japan and China, individuals avoid expressing their pain to maintain dignity and avoid burdening others (Good et al., 1991). 

Healthcare providers need to understand how different cultures perceive and manage pain to be culturally competent while treating patients. This involves acknowledging culture's role in shaping an individual’s experience of pain, along with their expectation for treatment. Cultural differences in the understanding and expression of pain may result in inadequate care, potentially harming the patient. By improving communication, employing active listening, integrating patients’ preferences for treatment, and utilising culturally sensitive assessment tools, healthcare providers can be more aligned with the patient’s cultural values (Beach et al., 2005). Understanding the patient’s cultural context enables caregivers to ask relevant questions, assess non-verbal cues, and attend to their worries in a way that respects their cultural roots (Campinha-Bacote, 2002). This improves the therapeutic alliance, leading to greater trust and satisfaction in the healthcare system. For instance, individuals from African and Hispanic cultures may communicate pain differently, and culturally competent doctors can prevent misdiagnosing patients or undertreating pain. 

A study conducted at Georgetown University showed that African Americans are more inclined to believe that they were disrespectfully treated, such as being spoken to rudely or feeling ignored. Furthermore, as compared to other groups, Asian Americans are the most likely to report that their doctor was judgemental towards them and least likely to feel that their practitioner understood their culture and values (Ihara, 2019). Such differences can be due to the workers’ lack of cultural competency, which may result in prejudices, implicit biases, or misunderstandings about how various cultural groups express and experience pain. By promoting culturally driven universal practices, caregivers can eliminate such disparities and offer more equitable care. 

Being culturally competent while treating patients can also address disparities in pain treatment. Research has shown that racial and ethnic minorities often receive less adequate pain management as compared to white patients. Latinos and African Americans are frequently undertreated for their illnesses in emergency rooms (Green et al., 2003). 

Pain is culturally bound, as it defines how people evaluate, communicate, and respond to it within a certain culture when interacting with other people. To ensure personalised care, caregivers must develop cultural competency to understand and respect pain experiences across cultures.