IUPUI psychologists explore pain in Hispanic Americans
Hispanic Americans report fewer pain conditions compared with non-Hispanic white or black Americans, according to a critical review and analysis of more than 100 studies on pain experience and pain management among Hispanic Americans. The first work of its type was conducted by researchers from the School of Science at Indiana University-Purdue University Indianapolis led by clinical health psychologist Adam T. Hirsh.
While the IUPUI researchers found that Hispanic Americans reported fewer pain conditions, they also found that Hispanics reported greater pain sensitivity and less pain tolerance in laboratory-based studies than non-Hispanic white Americans.
Hispanic Americas were more likely than non-Hispanic whites to report using religious coping for pain management. Hispanic Americans report frequently seeking nontraditional pain care outside of the United States and using off-label medications and "hot" treatments such as teas, herbs and massage.
Hispanic ethnicity, speaking Spanish as a primary language and lower levels of acculturation were found to be significant predictors of lower access to pain treatment.
Fifty-five million Hispanics live in the United States, representing almost 17 percent of the nation's population, but little is known about their pain-related experience.
"We know that Hispanic Americans' pain experiences are different from other Americans', but we don't know why," said Hirsh, an assistant professor of psychology. "Might these disparities be due to differences in pain processing, pain-coping strategies, cultural factors or a combination of these factors?"
To help answer this and other questions, the researchers summarized the perspectives of Hispanic-American patients and their health care providers, highlighting findings from the existing literature and gaps in need of future research. "The Pain Experience of Hispanic Americans: A Critical Literature Review and Conceptual Model" appears online ahead of print in The Journal of Pain. Authors in addition to Hirsh are graduate student Nicole A. Hollingshead, associate professor of psychology Leslie Ashburn-Nardo and associate professor of psychology Jesse C. Stewart, all of the School of Science at IUPUI.
The study was supported by grant R01MD008931 from the National Institute on Minority Health and Health Disparities of the National Institutes of Health.
One area underscored by the authors for future investigation is whether Hispanic Americans' cultural beliefs and attitudes serve as potential protective factors in the development of pain conditions. Increased levels of social support, mental health and work satisfaction have been shown to affect chronic pain for Americans in general. Does the Hispanic culture's emphasis on family and work values play similar protective roles against the development of chronic pain? What role does machismo play?
Exploring nonmalignant pain, pain behaviors and pain treatment-seeking among Hispanic Americans, the IUPUI researchers reviewed a total of 117 peer-reviewed studies. Hispanic Americans reported fewer pain conditions—lower rates of chronic pain, neck pain, acute and chronic back pain, joint and muscle disorder-type pain, lower- and upper-extremity pain, and diagnosed arthritis—compared with non-Hispanics.
Non-pain research has shown that Hispanic-American workers have very low rates of short-term work loss but the highest rate of long-term work loss, according to Hirsh. "This suggests that in the short term, Hispanic Americans are pushing through pain, but it catches up to them in the long term," he said. "This needs future exploration, as does the impact of acculturation—the adoption of the behaviors, beliefs and cultural elements of the dominant group in the society."
Hispanic Americans face numerous barriers to pain care including financial constraints, lack of insurance, insufficient English-language fluency and problematic immigration status.
Hispanics in the U.S. have a median age of 28 years, according to the U.S. Census Bureau. The median age of non-Hispanic whites is 42 and of non-Hispanic blacks is 33. Because pain, particularly chronic pain, conditions are more common among older adults, the IUPUI researchers point out that age may play some role in the observed ethnic differences in pain prevalence and that the age factor should be explored.
"There may be biological reasons, psychological reasons, social reasons and system-level reasons why Hispanic Americans appear to experience pain differently from other groups and why their treatment for pain may differ," said Hirsh. "Pain is the number-one reason Americans go to the doctor and a significant cause of disability. It's important for all of us—including the clinicians who treat them—to gain a clearer understanding of pain and its treatment in the rapidly growing Hispanic population in the United States."
According to the American Academy of Pain Medicine, chronic pain affects more Americans than diabetes, heart disease and cancer combined.