Pain across the cultures

7 December 2001

Published in The Age

“To be born is to suffer,” said the Buddha, and there’s little doubt that - for our incarnation into fragile bodies and perilous environments - we humans have always paid with a certain amount of pain.

Palaeolithic humans endured sepsis and accidents, medieval people the great epidemics, and we endure the diseases of civilisation.

There’s also the matter of human-inflicted pain. Australia’s Arunta people circumcised their young men with flint knives.
At an Italian archaeological site, Neolithic skeletons have had teeth removed for cosmetic reasons, and the Iron Age yielded up bronze arrowheads buried in bone.

Whether it’s been Christ or the proletariat who bled and suffered, pain has also defined entire historical movements - and is still at the forefront of human experience. We now have international pain journals, national pain societies, pain websites, and pain clinics - indeed www.pain.com lists 2,600 of them in the US alone.

US pain expert Dr Daniel Brookhoff, of the University of Tennessee, writes: “In the United States, nearly one third of the population experiences severe chronic pain at some point in life.”

Unsurprisingly, pain management is a growing medical specialty. With its appearance have come some changing attitudes:

“Less than fifty years ago,” writes Dr Brookhoff, “some medical textbooks discussed the need for patients to experience pain and suffering at the end of life so that they would relate to the agony of Christ, and prepare for redemption. Although few physicians still hold these views, many continue to imply that pain should be accepted without complaint, telling their patients that ‘after all, pain is not going to kill you’."

But Dr Brookhoff says that too much pain can indeed be fatal, and argues that pain is now sufficiently widespread to be viewed as a disease in its own right.

Perhaps the best-known author on pain, Dr David B Morris, lends the argument some philosophical depth in The Culture of Pain - arguing that we postmodern people must ditch the old boundary between disease (what happens from a doctor’s perspective) and illness (what happens from the patient’s).
 
Certainly a more holistic approach is taking root in the West. Therapies such as yoga, relaxation and  acupuncture are being used more. And pain management is now addressing the patient’s psychological and social being as well as his nerve endings.

Pain derives from a intimidating array of causes, including sciatica, virus infections, cancer, AIDS, operations, sports injuries, and even phantom limbs following amputation.

Pain usually begins when local nociceptors - free nerve endings - on (say) your foot are stimulated when something like heat or injury damages tissue. The kind of pain that attracts most attention these days is chronic pain, which (it goes without saying) can interfere with sleep, social life, eating, exercise and just about everything else.

One of the few international studies of chronic pain prevalance is by Dr Michael Von Korff of the Center for Health Studies in Seattle, USA, and associates. Interestingly, they found that a psychological disorder and a pain disorder “predicted” each other to the same degree.

How might this knowledge be useful clinically?

Dr Von Korff told The Age that, for example, “If clinically significant depression is present in a person with chronic back pain, it may be helpful for this condition to be diagnosed and treated.”

Dr Von Korff doesn’t think “there is much reliable knowledge about cross-cultural differences in attitudes toward pain”.

Others have made observations from their own experience. Jennifer Byrne, lecturer in acupuncture at the Australian College of Natural Medicine, says:

“For thousands of years Chinese healers have employed ‘analgesic’ and well as ‘constitutional’ acupuncture points.

“But though the Chinese do get their pains treated, they don’t do so with the same apparent obsession as we in the West. This could have something to do with the fact that they’re more stoical, or more accepting.” Byrne believes this may also have a “pragmatic historical context”: that the Cultural Revolution-inspired resurgence of Traditional Chinese Medicine left the country with less Western drugs, including analgesics.

Ngoat Vu, a Vietnamese community health worker with Northern Metropolitan Community Health Services in South Australia, says Vietnam’s drug shortages may have helped create the same stoicism.

She adds that “Vietnamese people’s attitudes in coping with pain are strongly affected by their beliefs and religions. For example the Buddhists believe that suffering is the consequence of sins and mistakes in a previous life. Happy and calm acceptance of punishments will resolve individual karma. The Christians believe pain is God's mercy for the individual and his family to pay for the individual's sins.”

Ngoat Vu feels that many cultures have the concept that “real men don’t cry” - but that it’s stronger in Asia.

US medical anthropologist Dr Geri-Ann Galanti is one of the country’s experts on differing cultural responses to pain, and author of the book Caring for Patients From Different Cultures. She writes:

“Nurses usually report that ‘expressive’ patients often come from Hispanic, Middle Eastern, and Mediterranean backgrounds, while ‘stoic’ patients often come from Northern European and Asian backgrounds.”