A Review of the Experience, Epidemiology, and Management of Pain among American Indian, Alaska Native, and Aboriginal Canadian Peoples

Abstract

Substantial literature suggests that diverse biological, psychological, and sociocultural mechanisms account for differences by race and ethnicity in the experience, epidemiology, and management of pain. Many studies have examined differences between Whites and minority populations, but American Indians (AIs), Alaska Natives (ANs), and Aboriginal peoples of Canada have been neglected both in studies of pain and in efforts to understand its biopsychosocial and cultural determinants. This article reviews the epidemiology of pain and identifies factors that may affect clinical assessment and treatment in these populations. We searched for peer-reviewed articles focused on pain in these populations, using PubMed, CINAHL, Cochrane, and the University of New Mexico Native Health Database. We identified 28 articles published 1990-2009 in 3 topic areas: epidemiology of pain, pain assessment and treatment, and healthcare utilization. A key finding is that AI/ANs have a higher prevalence of pain symptoms and painful conditions than the U.S. general population. We also found evidence for problems in provider-patient interactions that affect clinical assessment of pain, as well as indications that AI/AN patients frequently use alternative modalities to manage pain. Future research should focus on pain and comorbid conditions and develop conceptual frameworks for understanding and treating pain in these populations.Perspective-We reviewed the literature on pain in AI/ANs and found a high prevalence of pain and painful conditions, along with evidence of poor patient-provider communication. We recommend further investigation of pain and comorbid conditions and development of conceptual frameworks for understanding and treating pain in this population.

Representations of Indigenous Peoples and Use of Pain Medication in Canadian News Media

“…All other media items (n = 18) portrayed the use of opioid pain medication among First Nations peoples as a substance use problem, rather than as a way of managing chronic pain. Claims about opioid use and misuse as abstracted from the prevalence of chronic pain are particularly problematic in the case of population groups, such as Indigenous peoples, because of the high rates of chronic pain from various forms of injuries, trauma, and interpersonal and structural violence rooted in many peoples' ongoing experience of colonialism (Barkwell, 2005;Elliott, Johnson, Elliott, & Day, 1999;Green et al, 2003;Haskell & Randall, 2009;Jimenez, Garroutte, Kundu, Morales, & Buchwald, 2011). The silence regarding experiences of pain is especially troubling when contrasted with media items relating to nonFirst Nations populations, which focused more often on the use of opioids for pain management than on substance use problems (Picard, March 5, 2012; the National Post, November 14, 2011; Weeks, February 26, 2012).…”

The healing relationship in Indigenous patients' pain care: Influences of racial concordance and patient ethnic salience on healthcare providers' pain assessment

“…The extant research suggests that providers tend to assess Indigenous patients' pain as lower than that of other U.S. racial groups (Jimenez et al, 2011;Tait, Chibnall, & Kalauokalani, 2009). Some providers are more likely to dismiss Indigenous patients' reported pain levels or see them as overreporting their pain compared to patients from other racial groups (Bernabei et al, 1998;Miner et al, 2006).…”

“…The extant literature suggests that cultural barriers in communication impede the patientprovider relationship and subsequently reduce effective pain care among Indigenous populations (Jimenez et al, 2011). Given that pain is culturally experienced and communicated (Callister, 2003;Carlsson, 1983;Cintron & Morrison, 2006;Crowley-Matoka, Saha, Dobscha, & Burgess, 2009;Gatchel et al, 2007), cultural differences between providers and patients may interfere with understanding patients' pain symptoms.…”

“…Overall, despite the high disease burden of pain among Indigenous groups, research including pain assessment and providers' perceptions among Indigenous patients has been neglected (Jimenez et al, 2011). Such research is needed because underestimation of patients' pain could decrease effective pain care (Green et al, 2003;Jimenez et al, 2011;Tait et al, 2009).…”

“…American Indian Alaska Natives, or as herein referred to, Indigenous populations, experience significantly higher chronic pain rates than other U.S. racial groups (Jimenez, Garroutte, Kundu, Morales, & Buchwald, 2011;Wilson et al, 2011). Pain disparities in Indigenous populations may stem from their shared history of oppression and systemic discrimination, which subsequently set a path toward health disparities for present generations (Evans-Campbell, 2008;Sotero, 2006;Yellow Horse Brave Heart, 2003).…”