In Attention to Pain: Governance and Bodies in Brazil.

Ethnographies of bodies have become entry points for understanding the sensorially rich ways that worlds are generated and lived. Here, I adduce a slow-paced ethnographic mode that centers how bodily pain and touch orient attention, with a focus on gendered and racialized violence in the suburbs of Rio de Janeiro. In doing so, I make explicit the expectation in Rio's urban governance that resilience means toughening through pain. In turn, I detail how Pentecostal practices of 'healing touch' link pain and hope together, demonstrating the religious work, care, and governance involved in producing and maintaining hope under conditions of violence.

Maori lived experience of osteoarthritis: a qualitative study guided by Kaupapa Maori principles.

INTRODUCTION Osteoarthritis adversely affects people's quality of life; however, the effects of osteoarthritis on Maori in New Zealand remain unknown. AIM To explore the Maori lived experience of osteoarthritis. METHODS A qualitative study guided by Kaupapa Maori principles. Maori adults (≥30 years) with clinical knee or hip osteoarthritis took part in semi-structured interviews that were recorded and transcribed. Thematic analysis and a model of Maori health (Te Whare Tapa Wha, outlining four dimensions of wellbeing (taha tinana- physical; taha hinengaro- mental; taha wairua- spiritual; and taha whanau- family)) were used to analyse data. RESULTS Seven Maori females aged 44-71 years participated. Physical manifestations of osteoarthritis, namely pain and limited daily activities, affected mental, spiritual and family wellbeing. Participants experienced whakama (shame) and frustration. Cultural duties such as attending the marae were impeded, affecting spiritual wellbeing and cultural identity. Participants described drawing on the strength of their ancestors to cope with their impairments. Western medicine was commonly used, although side-effects were prominent and few participants had received information about the condition from health professionals. Both positive and negative experiences of health-care and treatments were reported. DISCUSSION Osteoarthritis inflicts a substantial burden on the physical, mental, spiritual and family wellbeing of Maori women. Primary care practitioners must consider spiritual and family wellbeing when providing care for Maori with osteoarthritis. Culturally sensitive education for patients and their whanau is needed.

Clinical effect of hyperbaric oxygen therapy in the treatment of femoral head necrosis : A systematic review and meta-analysis.

BACKGROUND: Although many clinical studies have shown that hyperbaric oxygen (HBO) therapy in the treatment of femoral head necrosis can significantly improve clinical symptoms and patients' quality of life, this conclusion has not been systematically evaluated. Therefore, a meta-analysis was performed to systematically evaluate the clinical effect of HBO therapy in the treatment of femoral head necrosis. METHODS: PubMed, Embase, and Web of Science databases, as well as the reference lists of relevant studies published before August 2016 were systematically searched using terms related to HBO and femoral head necrosis. Fixed or random effects models were used to estimate the pooled risk ratio (RR) with 95% confidence intervals (CI). Several subgroup analyses, sensitivity analyses, and publication bias tests were carried out to explore potential study heterogeneity and bias. RESULTS: Nine studies involving 305 controls and 318 HBO cases were included. The clinical effect in the HBO therapy group was 4.95-times higher than in the control group (odds ratio, OR = 4.95, 95% CI [3.24,7.55], P < 0.00001) and the difference was statistically significant. According to the principle of subgroup analysis, the population was divided into Asian and non-Asian subpopulations. Subgroup analyses showed that the clinical effect in the HBO therapy group was 4.77-times higher than that of the control group of the Asian subpopulation (OR = 4.77, 95% CI [3.06,7.44], P < 0.00001) and 7.07-times than that of the control group of the non-Asian subpopulation (OR = 7.07, 95% CI [1.77,28.27], P < 0.00001). CONCLUSION: The results of this study showed that HBO therapy can significantly improve the clinical treatment effect in patients with femoral head necrosis, and that this treatment approach is worthy of clinical application.

[Cultural interpretation of pain in family-oriented societies]. / Kulturelle Deutungen des Schmerzes in familienorientierten Gesellschaften.

Patients from different cultures, particularly from family-oriented societies, such as the Near and Middle East, southern Italy and Greece, have a different perception of pain and other healing expectations, even in contact with doctors, than for example patients in western societies. This aspect is not sufficiently taken into consideration by modern multimodal therapy approaches. The pain experienced is not limited to one part of the body but needs to be seen holistically in relation to the whole body. The limited access of patients to psychological complaints often leads to chronic pain or other physical complaints. For therapy and the therapist-patient relationship, it is essential to understand the significance of the pain experienced in the construction and experience of interpersonal relationships. The diseased body is an expression of the social, collective, economic, migrational history, mental and cultural state of mind of the patient; therefore, in the treatment of patients from traditional cultures a multimodal, interdisciplinary and culturally sensitive approach is necessary for effective pain treatment.

American Indians' response to physical pain: functional limitations and help-seeking behaviors.

Seventy-five American Indians, ages 25 to 84, representing 14 tribal nations, participated in this study. The historical, cultural, and behavioral responses to physical pain were examined. Data were collected over a 7-month period with a survey instrument that included the Universal Pain Scale, activities of daily living, causes of pain, cultural beliefs, and self-help-seeking behaviors. Also, recommendations for Western biomedical health care professionals are offered to improve services for the American Indian population. Findings demonstrate that culture plays a crucial role in wellness and significantly affects help-seeking behaviors, treatment regimens, responses to pain, and pain management.

A characterization of pain in racially and ethnically diverse older adults: a review of the literature.

This article presents a critical review of the influence of interracial and ethnic variation on pain prevalence, intensity, interference/function/disability, and treatment in older adults. A search of scientific databases published from 1900 to 2011, using key words associated with pain, geriatrics, and race/ethnicity, identified 180 articles, of which 27 empirical studies met the inclusion criteria. Of the retained articles, 17 reported that race/ethnicity was a statistically significant factor at p < .05. Minority older adults reported a higher prevalence of pain and higher pain intensity, and variable responses regarding function/disability compared with responses by non-Hispanic White older adults. Minority older adults were less likely to receive prescription pharmacologic treatments and surgery, and they were more likely to use complementary and alternative medicine treatments. There are interracial/ethnic differences in pain assessment and treatment interventions among older adults.

Uncertainty, culture and pathways to care in paediatric functional gastrointestinal disorders.

This paper examines how children and families of diverse ethnic backgrounds perceive, understand and treat symptoms related to functional gastrointestinal disorders (FGIDs). It is questioned how different ways of dealing with medical uncertainty (symptoms, diagnosis) may influence treatment pathways. Semi-structured interviews were conducted with 43 children of 38 family groups of immigrant and non-immigrant backgrounds. The analysis takes into account (a) the perceived symptoms; (b) the meaning attributed to them; and (c) the actions taken to relieve them. The social and cultural contexts that permeate these symptoms, meanings and actions were also examined. It is found that, in light of diagnostic and therapeutic uncertainty, non-immigrant families are more likely to consult health professionals. Immigrant families more readily rely upon home remedies, family support and, for some, religious beliefs to temper the uncertainty linked to abdominal pain. Furthermore, non-immigrant children lead a greater quest for legitimacy of their pain at home while most immigrant families place stomach aches in the range of normality. Intracultural variations nuance these findings, as well as family dynamics. It is concluded that different courses of action and family dynamics reveal that uncertainty is dealt with in multiple ways. Family support, the network, and trust in a child's expression of distress are key elements in order to tolerate uncertainty. Lastly, the medical encounter is described as a space permeated with relational uncertainty given the different registers of expression inherent within a cosmopolitan milieu. Narrative practices being an essential dynamic of this encounter, it is questioned whether families' voices are equally heard in these clinical spaces.

Catechol-O-methyltransferase polymorphisms do not play a significant role in pain perception in male Chinese Han population.

Polymorphisms in the human catechol-O-methyltransferase (COMT) gene have been widely studied for their role in pain and analgesia. In this study, sensitivity to potassium iontophoresis, visual analog scale measurements for fixed twofold pain threshold stimulation and pain threshold changes induced by transcutaneous electrical acupoint stimulation (TEAS) were assessed in a population of healthy Chinese males. These results were correlated with the alleles of six single nucleotide polymorphisms (SNP) or diplotypes of common haplotypes designated as low pain sensitive, average pain sensitive, and high pain sensitive in the COMT gene of these subjects. Our results reveal that the alleles of each SNP are not significantly correlated with pain perception except for the rs4633 allele in the 2 Hz TEAS session (P < 0.05). In addition, the six diplotypes of COMT haplotypes, which cover 92.5% of the Chinese population, are also not correlated with pain perception. Moreover, there were no significant differences in pain threshold changes induced by 2 and 100 Hz TEAS among the diplotypes of each SNP or the various haplotypes. These results suggest that COMT activity do not play a significant role in pain perception and TEAS-induced analgesia in the Chinese Han male population.

Spiritual expressions of African Americans and Whites in cancer pain.

BACKGROUND: Spiritual practices are one way that individuals cope with cancer pain. PURPOSE: Describe and contrast expressions and values about the use of spirituality for pain in African American (AA) and White (WH) oncology patients. METHODS: Six groups (3 AA; 3 WH; n=42; mean age 58) were conducted. Focus group and qualitative methodology with a cultural interpretive lens was utilized. The Model of Integrated Spirituality provided the conceptual framework for understanding the narratives. FINDINGS: AAs and WHs did not differ on demographics, pain status, or integrative therapies. Three spirituality themes emerged: 1) pain and distress as antecedents to the use of spirituality; 2) active and existential attributes of the use of spirituality; and 3) mobilization of internal and external resources as outcomes. There were commonalities between AAs and WHs but greater frequency of certain subthemes and keywords in AAs. CONCLUSIONS: Future studies should examine whether differences in overt expressions translate into different types and levels of spiritual usage. IMPLICATIONS FOR PRACTICE: Clinicians should recognizing similar as well as different uses and descriptions of spirituality between African Americans and Whites.

Pain in underserved community-dwelling Chinese American cancer patients: demographic and medical correlates.

BACKGROUND: Little is known about cancer pain in Chinese Americans. The objective of this study was to describe the epidemiology of pain in this population. This information is needed to identify and address unmet clinical needs for culturally relevant interventions targeting pain and its consequences. METHODS: A consecutive sample of underserved ethnic Chinese patients in a large community-based oncology practice was screened for persistent or frequent pain. Those patients with pain completed translated instruments assessing demographics, linguistic acculturation, disease-related characteristics, and pain-related characteristics. RESULTS: Of 312 patients screened, 178 (57.1%) reported frequent or persistent pain, 175 were eligible, and 170 participated. Most participants (85.9%) were born in China and 84.7% overall spoke Cantonese only. The most common cancers were gastrointestinal (28.2%), lung (21.8%), breast (20.6%), head and neck (12.9%), and genitourinary (4.7%); 43.5% had metastatic disease. The mean worst pain severity on a 0-10 numeric scale was 4.7 (standard deviation, 2.4), with 28.2% of patients rating their worst pain at ≥7 of 10. Although 37.6% used opioids and 47.1% used nonopioids, 45.8% reported "little" or "no" pain relief from medications. Complementary or alternative medicine therapies for cancer pain were used by 35.8%. In multiple regression analyses, worst pain was positively associated with acculturation to the English language and opioid therapy, and pain-related distress was positively associated with opioid therapy. CONCLUSION: Pain is prevalent among community-dwelling, ethnic Chinese American cancer patients. Additional studies are needed to confirm these results and investigate the finding that higher linguistic acculturation is associated with reports of more intense pain.

Use, perceived effectiveness, and gender differences of pain relief strategies among the community-dwelling elderly in Taiwan.

Pain is a common problem among the elderly. The entire scope of chronic pain relief strategies used by community elderly is still unclear. A limited number of studies have investigated this issue from diverse culture perspectives. In the present study, we investigated the use and perceived effectiveness of pain relief strategies adopted by the elderly; gender differences between frequently used relief strategies were also explored. Two hundred nineteen participants living in Taiwan City, Taiwan, were recruited by a random sampling method and interviewed face to face. The prevalence of chronic pain among the elderly was 42.0% (n = 92). The elderly tended to adopt multiple strategies (mean ± SD = 9.08 ± 3.56; range = 2-18) to relieve their chronic pain. In three domains of pain relief strategies, conventional medicine was used more frequently than complementary and alternative medicine and psychologic approaches. Most pain relief strategies were ineffective. Among the 22 strategies used, no strategy was reported as "much improved" by a majority of users. The top five pain relief strategies used by men and women were the same. Elderly women tended to adopt more psychologic approaches, such as acceptance and ignoring to relieve pain, than men. The findings suggest that nurses should pay more attention to the issue of chronic pain relief and provide the elderly with more effective pain relief strategies.

Understanding the cancer pain experience in American Indians of the Northern Plains.

OBJECTIVE: The purpose of this study was to explore the experience of cancer pain in American Indians (AI) from the Northern Plains region of the United States. DESIGN: This was a qualitative descriptive study. SETTING: Southeastern Montana. PARTICIPANTS: The sample consisted of 10 participants from Northern Plains AI tribes/nations, aged 31-75 years, with both solid and hematologic malignancies. MAIN OUTCOME MEASURES: Data were produced through semi-structured interviews and through the use of the Brief Pain Inventory-Short Form. RESULTS: Participants reported mild-to-moderate pain on a daily basis, and pain negatively interfered with their daily activities and enjoyment of life. The average pain score at the time of interview was 4.2 out of 10. Participants described both somatic and neuropathic pain. Participants reported psychosocial distress through feelings of guilt, depression, and isolation related to their cancer, and they relied strongly on prayer and traditional medicine in coping with pain. Dominant themes were 'Isolating Within' and 'Making Connections'. CONCLUSIONS: This study suggests that there is very little difference between AI and other cultural groups regarding cancer pain in the description of pain, patterns, and types of pain management. However, this study identified notable differences in the high degree of isolation reported by AI, their desire to endure pain with stoicism, their intense desire to protect their privacy, and their distrust of outsiders. Findings from this study will inform future research on pain and pain interventions in AI patients with cancer.

Life satisfaction in chronic pain patients: the stress-buffering role of the centrality of religion.

Chronic pain (CP) is a stressful condition that severely impacts individuals' lives. Researchers have begun to explore the role of religion for CP patients, but the literature is scarce, especially for West European populations. Drawing from the transactional theory of stress, this study examined the associations between the religious meaning system and the life satisfaction for a group of CP patients who were members of a Flemish patients' association. To take into account the religious landscape of West European countries, the centrality of one's religious meaning system, rather than religious content, was the focus. Results from the questionnaires completed by 207 patients suggest that the centrality of a meaning system is an important factor in the promotion of life satisfaction for this group, above and beyond the influence of several control variables. Furthermore, the centrality of the religious meaning system moderated or buffered the detrimental influence of pain severity on life satisfaction.

A pilot study of relationships among pain characteristics, mood disturbances, and acculturation in a community sample of Chinese American patients with cancer.

PURPOSE/OBJECTIVES: To describe the pain experience of Chinese American patients with cancer and to examine the relationships among pain characteristics, demographic characteristics, performance status, self-reported analgesic use, mood disturbances, and patients' acculturation levels. DESIGN: Descriptive, correlational, cross-sectional study. SETTING: Three community-based oncology facilities in the San Francisco, CA, Bay area. SAMPLE: 50 Chinese Americans who reported experiencing pain from cancer. METHODS: Participants completed in their preferred language a demographic questionnaire, the Karnofsky Performance Status Scale, the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, the Suinn-Lew Asian Self-Identity Acculturation Scale, and information about analgesic use. Descriptive and correlational statistics were used to evaluate data. MAIN RESEARCH VARIABLES: Pain intensity, pain interference, performance status, anxiety, depression, analgesic use, and acculturation level. FINDINGS: Most of the patients reported moderate to severe pain and moderate levels of interference. Lower levels of acculturation were associated with higher least and worst pain intensity scores and higher pain interference scores. Anxiety and depression scores were in the moderate range. Higher depression scores were associated with higher pain interference scores. Self-reported analgesic use for 62% of the patients was classified as inadequate. CONCLUSIONS: A significant percentage of Chinese American patients experience moderate to severe cancer pain that affects their mood and their ability to function. IMPLICATIONS FOR NURSING: Nurses should assume a proactive role in assessing the physical, emotional, and cognitive dimensions of pain in Chinese American patients. Future research should evaluate the cancer pain experience of these vulnerable patients and develop and test culturally appropriate interventions.

Arthritic pain among Latinos: results from a community-based survey.

OBJECTIVE: To examine factors associated with pain among Latinos with arthritis, identify common coping strategies and potentially effective interventions, and determine whether pain levels affect the level of interest in potentially useful programs. METHODS: Using a convenience sampling approach and a combination of face-to-face and telephone surveys, 588 Latino adults in Oregon with arthritis were interviewed. The intensity of pain during a typical day was assessed using a scale ranging from 0 (no pain) to 10 (worst pain). A score of >or=7 was defined as severe pain. RESULTS: More than 60% of Latinos reported severe pain. Results from an ordinary least square regression indicated that among Latinos with arthritis, women, those with lower levels of education, and those reporting poor or fair self-rated health and functional limitations had higher levels of pain, after controlling for confounders. Those with severe pain were more likely than those with lower levels of pain to use over the counter medicine and home remedies to manage their arthritis. In addition, Latinos with greater pain were more likely to be interested in arthritis management programs. CONCLUSION: These findings have important implications for public health policy. The strong interest of Latinos in various arthritis and joint pain management programs could prove to be an important avenue for supporting a population with high levels of arthritic pain and lack of health insurance. These pain management programs are all the more appealing, given the availability of a number of evidence-based, low-cost interventions.

Self-reported pain and utilization of pain treatment between minorities and nonminorities in the United States.

OBJECTIVES: To investigate differences in reported pain and pain treatment utilization (use of over-the-counter and prescription pain medications, seeing a pain specialist, and use of complementary and alternative medicine) among minorities and nonminorities in the general population. DESIGN: Secondary analysis of a national probability survey conducted by the CBS News/New York Times in January 2003. SAMPLE: Adult population in the United States, 18 years or older, having a telephone line at home. MEASUREMENTS: The survey asked respondents a series of questions about demographics, pain characteristics, and utilization of pain treatment; logistic regression was used to identify variables predicting reported utilization of pain treatment. RESULTS: Of the 902 respondents completing the survey, 676 (75%) reported experiencing "any type of pain." Of these, 17% reported being diagnosed with chronic pain. Minorities reported a higher average daily pain than Whites (4.75 vs. 3.72; p<.001). However, race/ethnicity did not explain utilization of pain treatment; income, education, age, gender, and pain levels explained more variability in different pain treatment utilization variables than race/ethnicity. CONCLUSIONS: Although minorities report higher pain levels than Whites, race/ethnicity does not explain utilization of treatment for pain. Future studies should consider more nuanced examination of interactions among race/ethnicity, pain, and socioeconomic variables.

The effect of cultural background on the usage of complementary and alternative medicine for chronic pain management.

BACKGROUND: Chronic pain is a debilitating problem with significant impact on healthcare utilization in the US. Many chronic pain patients use complementary or alternative medicine (CAM) in addition to standard pharmacologic therapy. OBJECTIVE: The aim of our study was to identify differences in the characteristics of usage of CAM for chronic pain control among several ethnic groups. DESIGN: We recruited 92 consecutive patients seeking treatment at the pain clinic and interviewed them using a questionnaire. RESULTS: The most common pain complaint was back pain (55.4%) and the mean pain duration for all chronic pain problems was 9.8 years. Approximately 81% of respondents were using or have used CAM before. The commonest CAM used by patients in our study included massage therapy, spiritual healing as well as the consumption of mineral and vitamin supplements. Sixty-three percent of them were satisfied with CAM treatment compared to 56% of patients who were satisfied with prescription therapy. However, there was no difference in the use of CAM among the different ethnic groups (P > 0.05). CONCLUSION: Our study demonstrates that CAM is used very frequently in patients with chronic pain. However, it did not show any ethnic or racial differences in CAM utilization.

Complementary and alternative medicine for pain management in U.S.- and foreign-born Chinese women with breast cancer.

This study explores beliefs about complementary and alternative medicine (CAM) use for pain management among 15 U.S.-born and 15 foreign-born Chinese women with breast cancer. For this investigation, trilingual interviewers conducted individual, face-to-face, qualitative interviews in Cantonese, Mandarin, or English. All study participants lived in San Francisco, and the foreign-born women had resided in the U.S. for 15 years or fewer. Findings indicate that many participants consider CAM a viable method of pain management. However, concerns about affordability and quality of treatment prevent some women from using CAM on a regular basis. Many participants indicated that Western health care providers are poorly equipped to provide CAM to manage the pain resulting from breast cancer treatment. Future research should explore how access to CAM can be improved for poor and uninsured patients with cancer and how alternative approaches to pain management can be integrated more broadly in the U.S. health care system.