As of 2011, there were 18.2 million Asian Americans in the United States. Asian Americans are faced with a unique set of issues in chronic pain care. The only way to combat these issues is to recognize them and come up with actionable ways to resolve or reduce the issues.
The term “Asian” includes several different ethnicities.
In 2011, the largest Asian American groups were Chinese, Filipino, and Asian Indian. The next most populous groups of Asians are Vietnamese, Korean, and Japanese people. However, these populations are not the only Asian groups, as noted by the Centers for Disease Control and Prevention (CDC), which states:
“The Office of Management and Budget (OMB) defines ‘Asians’ as people having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.”
Asians in the United States still suffer from discrepancies and discrimination in healthcare.
Asians are often considered the “model minority,” meaning that all Asian people are believed to be well-educated, financially well-off, and of a high socioeconomic status. However, this is not the case. While there are certainly Asian Americans who do fit the parameters of the model minority myth, many Asian Americans live at or below the poverty line. Many may not have insurance. They may also suffer from chronic conditions. In fact, the Asian population may be disproportionately affected by HIV/AIDs, hepatitis B, tobacco use, and tuberculosis.
Asian individuals also face discrimination. According to one study, common instances of everyday discrimination against Asian Americans are associated with indicators of pain, such as:
- Frequent or severe headaches
- Chronic pain
- Chronic back or neck problems
It was also found that discrimination is associated with analgesic and tranquilizer use. These medications are commonly used to treat pain, which can contribute further to pain-related issues among Asians. Additional problems were reported as being associated with cardiovascular care for Asian Americans.
Some of the pain-related discrepancies in healthcare for Asian people are culturally-related.
Researchers at the University of Missouri found that South Asians in the United States are more reluctant to seek medication therapy for pain. One possible reason for this is the mindset surrounding pain in many Asian cultures, as noted by an article from Dimensions of Culture:
“Patients from Asian cultures may often exemplify stoicism in the face of pain, which relates directly to strong cultural values about self-conduct. Behaving in a dignified manner is considered very important, and a person who is assertive or complains openly is considered to have poor social skills. This behavior might be tolerated in very small children, but not in adolescents and adults… Though an individual may feel sadness or pain, it is not customary to make this obvious.”
This stoicism concerning pain can have an effect on communication with healthcare providers. Because Asian people may be used to avoiding discussions about pain, they may be made uncomfortable by physicians’ questions concerning pain. Additionally, pain may not be described the same way in some traditional Asian cultures. While others might describe a pain experience as sharp or throbbing, an Asian individual – unaccustomed to discussions about pain – might describe that same experience as like lightning, tree roots, or drums.
Some religions practiced in Asian cultures also value the acceptance of pain as a demonstration of faith. If this is the case, an individual in pain may refuse pain medication because he or she believes the pain to be the will of a higher power. Pain medication may even be seen as self-indulgent.
Lastly, tools used to evaluate pain intensity commonly involve a numbered pain scale or a linear representation of faces varying from smiling to frowning. Some Asian cultures might associate certain numbers with superstitions, so a numbered pain scale may not be accurate. Smiling can have different associations in some cultures, such as embarrassment or anger, so a choice of faces varying from smiles to frowns may not be very accurate, either.
Discrepancies in pain management among Asian Americans can be lessened when healthcare professionals are aware of the problems.
Communication and trust must be the basis of pain management. Healthcare professionals, such as doctors and nurses, have to talk openly about the importance of pain management. Also, they must take all complaints of pain or discomfort seriously.
It may be helpful to devise creative methods of communicating pain intensities, too. If a patient is uncomfortable with faces or a numbered scale, his or her healthcare team should perhaps try to find another way to understand the individual’s discomfort level.
One way to improve communication and understanding between patients and professionals is to better educate healthcare professionals about cultural differences and discrepancies. Some students at the Albert Einstein College of Medicine have taken part in a three-month elective course designed to help bring attention to health disparities. The course involved role-playing and strategic planning, among other skills. At the end of the course, participants reported feeling significantly more confident about dealing well with health discrepancies.
Another way to possibly improve care for Asian people is the introduction of care guides. Allina Health is introducing two equity care guides into its healthcare team. These care guides are non-clinical professionals who support patients. The care guides do not dispense advice. Rather, they focus on identifying barriers to care and solutions to these barriers. Care guides might also help patients find resources or become more educated about their own care or medications.
How do you think we can lessen discrepancies in pain management among Asian Americans?
Image by Eddy Van 3000 via Flickr