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Cultural Differences in Pain Expression. Nancy Alvarado California State Polytechnic University, Pomona. Coauthors. Ralph B. Jester University of California, Irvine Christine R. Harris University of California, San Diego Julia F. Whitaker University of Utah, Health Sciences Center

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Cultural differences in pain expression l.jpg

Cultural Differences in Pain Expression

Nancy Alvarado

California State Polytechnic University, Pomona

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  • Ralph B. JesterUniversity of California, Irvine

  • Christine R. HarrisUniversity of California, San Diego

  • Julia F. WhitakerUniversity of Utah, Health Sciences Center

  • Funded by NIH MBRS/SCORE Grant S06 GM053933, 2006-2009

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Undertreatment for Pain

  • Chart review studies suggest routine under medication for pain of members of ethnic and racial minority groups in the USA.

  • This occurs regardless of the type of injury or medical condition, for both chronic and acute pain.

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Why does this happen?

  • Are members of such groups different in their:

    • Self report

    • Expressive behavior (including facial expression)

    • Physical reactivity (heart rate, blood pressure)

    • Pain tolerance

  • Or is the difference with the observers?

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Our Study

  • Multiple measures:

    • FACS coding of videotaped behavior

    • Pain attitudes questionnaire assessing cultural beliefs about pain and its expression

    • Physiological measures

    • Self-report using multiple scales

    • Acculturation questionnaires

  • Only FACS results are presented today.

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Pain Evoked by Cold Pressor

  • Subjects immersed left hand up to wrist in circulating cold water:

    • Held at 3 degrees Centigrade (+- .2)

  • Hand removed when subject could no longer tolerate the cold or reached the time limit (3 min.)

  • The colder water temperature was used to minimize sex differences.

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  • Four self-identified groups were tested:

    • Asian American

    • African American

    • Hispanic

    • European American (dominant culture)

  • ~50 subjects per group, Cal Poly students

  • 25 male, 25 female

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Coding Method

  • FACS – all AUs except head position and eye movements (Ekman & Friesen, 1978).

  • Frequency of occurrence, presence or absence of each AU by subject, duration not coded.

  • Events – as described by Ekman & Rosenberg (1997). What the Face Reveals.

  • Co-occurrence of AU 1+4, 4+7, 1+2, and 6+12 was also coded.

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  • We expected to find expressive differences related to subculture and sex.

  • We expected:

    • Asian Americans and Hispanics to be more stoic (less expressive)

    • African Americans to be more expressive.

    • Men to be less expressive than women.

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  • No strong sex differences in expressivity were observed, F(1,173)=2.56, p=.110.

  • No differences in events across cultural groups were observed, F(3,173)=0.66, p=.580.

  • Discriminant analysis showed better than chance prediction (group=45.3, sex=71.3), improved with segregation by acculturation

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Expected Pain AUs

  • The AUs found in previous pain studies were found here, equally in all four groups.

  • Distress expressions (AU 1+4) were more frequent among African American women.

  • Hispanic men showed more frowns (AU 4+7) and fewer smiles (AU 6+12) than Hispanic women.

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Smiling Smiling

  • Both Duchenne and non-Duchenne smiles occurred during the pain experience – with no experimenter present.

  • Smiling often occurred just before a subject signaled to remove the hand from the water.

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Conclusions Smiling

  • Cultural differences occurred in more general AUs (frowns, smiles, AU 1+4) not in pain AUs (grimaces, lip presses, AU 9 or 10).

    • Culture may influence social interaction more than expressivity directly related to pain.

  • Because results were stronger for less acculturated subjects, members of the wider community may show larger differences.

  • Our study lacked power – more subjects needed.