Cultural Context of Pain

Objectives

  1. Recognize and discuss factors leading to pain treatment challenges, variability, and access due to race, gender, ethnic, social and economic disparity
  2. Describe unique pain assessment and management needs of special populations
  3. Describe the role of the clinician as an advocate in assisting patients to meet treatment goals
  4. Explain how health promotion and self-management strategies are important to the management of pain
  5. Describe patient, provider, and system factors that can facilitate or interfere with effective pain assessment and management
  6. Design an individualized pain management plan that integrates the perspectives of patients, their social support systems, and health care providers in the context of available resources
  7. Reflect on the wider role of the clinician, within and beyond the healthcare system, as an advocate for patients suffering from chronic pain
  8. Describe the impact of pain on society

Before Class

1. Required reading

After reading the articles, write a short reflection that includes the following, and upload it to the pre-class quiz on Canvas.
For each article:

What is one finding in each article which surprised you? Why?
What is one thing you have a question about?
How and where will you seek answers to your questions?
One of the studies noted in the first article mentioned that some Native patients have an ‘expectation of empathy.’ The Native patients “expressed the conviction that it was the provider’s role to perceive and experience the patient’s pain in order to treat it” without the patient having to describe their pain in detail. What do you think about this? Do you believe this is possible across cultural beliefs and practices? Why or why not?

2. Required videos

Some questions to ponder as you watch:

In the field of medicine you are particularly interested in, how might historical trauma express itself in a patient’s life? What would be some possible physical, psychological or emotional manifestations?
Do you think historical trauma is different or the same as social determinants of health?

  • Interview with Chaplain Joisky Caudill: An Indigenous Perspective on Health and Wellness (12 min) 

    Some questions to ponder as you watch:
    How did Chaplain Joisky negotiate her care with her physicians? As a provider, how might you offer opportunities for your patients to negotiate their treatment with you? What would you do, say or ask?

Some questions to ponder as you watch:
What are ‘positive’ stereotypes about Native Americans/Alaska Natives? Why are they harmful?
What is your reaction when you hear Chaplain JoiSky’s definitions of medicine and health?  How would you know if your patients defined these concepts differently than you do? Why might that be important to be aware of?

There is mention that some Native people may understand illness and pain as manifestations of sickness of soul or as something which happens as a result of something a person was meant to do but hasn’t done. How would you work with patients who hold beliefs such as these? Would their beliefs change how you would provide care for them?

‘Racial Disparities in Pain Medication Use’ (10 min)

Review from EHM Cultural Humility Film (first 12 of 15 min) 

Historical Trauma: Hozhonahaslíí: Stories of Healing the Soul Wound Part III (11 min)

In Class

Students will work in small groups to discuss the case story with a community consultant.
Small groups should designate a member to write up a brief summary of their discussion with guest consultant (please include in your summary who your guest was, and the names of the people in your group).

The summary should include
1. One thing which was surprising to hear or was a new perspective
2. Two points of information you will carry forward as a future physician

We will reconvene as a large group for report out.

Please sign in for attendance of small group.

After Class

Healing the Warrior’s Heart