Chapter 4: Pain Assessment
Gillian Spring
Background
Pain assessment and management are not one-size-fits-all. Pain is an individual experience and should be treated as such. It is important to have many different tools and assessment approaches in the nursing “tool kit” to assess and treat all types of patients.
The Social Determinants of Health in Relation to Pain Management
- Evans et al. (2019) studied the pain intensity experience of older Black adults living in a low-income area of Los Angeles. They determined that age, financial struggles, pain-related chronic conditions, living alone, and depression lead to an increase in pain intensity (Evans, 2019).
- Janevic et al. (2018) studied pain intensity across a diverse patient population and discovered that White adults experience less pain-related disability than Black adults. Their study showed that socioeconomic disadvantages also have a negative impact on the prevalence of chronic pain, regardless of patients’ cultural backgrounds (Janevic et al., 2018).
- Disparities in pain treatment include poor or unfairly operated social, economic, and health policies for people in low income brackets (Booker & Herr, 2021). Patients in rural or impoverished areas have limited access to the health care services they need to manage chronic pain (Booker & Herr, 2021). Therefore, their pain is left untreated and becomes unbearable.
- Bierman and Lee (2018) discovered that racialized individuals who have faced lifelong stressors are at an increased risk of clinical depression if they experience severe or chronic pain.
Barriers to Adequate Pain Management for Racialized Patients
The burden of pain is unequal across cultural groups (Meints et al., 2019). Health care providers (HCPs) may lack knowledge or have implicit biases about spiritual and cultural practices for pain management.
HCP Barriers
- HCPs may believe myths, such as the idea that Black individuals experience less pain than White individuals due to biological differences (Hoffman et al., 2016). Not only does this myth contribute to racial disparities in health care, it can also lead to inadequate assessment and treatment of pain (Hoffman et al., 2016).
- Unconscious biases, stereotyping, and false beliefs may contribute to the improper assessment and/or mistreatment of pain among racialized patients (Meints et al., 2019).
- A general misunderstanding or lack of knowledge regarding effective pain management strategies may also cause HCPs to under-assess and under-treat pain (Slatyer et al., 2022).
Cultural Factors
- Each faith and culture may have a different understanding of what pain means and how it should be treated. There are also gender differences among cultural groups, which influence pain expression as well (Can et al., 2019).
- Certain cultures believe in stoicism and not showing or reporting pain (Bautista et al., 2021).
- Certain countries do not have access to opioids. Therefore, patients may not know they are a treatment option (Bau