Culture matters!!!   March 31st, 2023

Chronic pain is a common, difficult, and distressing problem that significantly impacts society and individuals. The cause of chronic pain is a complex interaction between biological, psychological, and social factors. Understanding chronic pain in the context of a bio-psycho-social model will help to develop treatment plans and prevention strategies. Pain neuroscience education (PNE) is an evidence-based intervention that incorporates the multidimensionality of a pain experience. It helps patients re-conceptualize pain through the understanding of the multiple neurophysiological, psychosocial and physical components that may be involved in their individual pain experience (Louw et al., 2016; Moseley & Butler, 2015).

The existing PNE material is limited to a few languages and cultural backgrounds. Many cultures also have distinct cultural beliefs regarding the meaning, origin, and role of pain, which can affect how a patient interprets and perceives pain (Davidhizar & Giger, 2004). Moreover, a growing body of research has indicated that behavioral interventions aligned to the norms and values of a specific cultural group are more effective for those groups compared to their original form. Therefore, evidence-based pain management strategies developed by clinicians in one culture may not necessarily be understood, appropriate, or effective in another culture.

Cultural adaptation is a good approach for the development of effective PNE material for subcultural groups. Cultural adaptation is “the systematic modification of an evidence-based treatment (or intervention protocol) to consider language, cultural, and context in such a way that it is compatible with the client’s cultural patterns, meaning, and values” (Castro et al.,2010).

Several models to guide cultural adaptations have been proposed. Although these models appear to have been developed independently, they exhibit considerable consensus. In one of the early-stage models, Barrera and Castro (2013) proposed a sequence of four intervention adaptation stages consisting of (a) information gathering, (b) preliminary adaptation design, (c) preliminary adaptation tests, and (d) adaptation refinement.

Future research should focus not only on the development of more culturally sensitive PNE material but also on the evaluation of these cultural adaptations, and to determine the effectiveness of these adaptations relative to the original versions.

Charbel Najem

PhD student, investigating the role of culture on the pain experience.

2023 Pain in Motion

References and further reading:

Barrera, M., Jr, Castro, F. G., Strycker, L. A., & Toobert, D. J. (2013). Cultural adaptations of behavioral health interventions: a progress report. Journal of consulting and clinical psychology81(2), 196–205.

Castro, F. G., Barrera, M., Jr, & Holleran Steiker, L. K. (2010). Issues and challenges in the design of culturally adapted evidence-based interventions. Annual review of clinical psychology6, 213–239.

Davidhizar, R., & Giger, J. N. (2004). A review of the literature on care of clients in pain who are culturally diverse. International nursing review51(1), 47–55.

Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy theory and practice32(5), 332–355.

Moseley, G. L., & Butler, D. S. (2015). Fifteen Years of Explaining Pain: The Past, Present, and Future. The journal of pain16(9), 807–813.