Perception of Pain Expression Among Surgical Patients and Families from Three Ethnic Groups of a Nation: A Multicenter Qualitative Study

Background

Despite its universal nature; perception, coping, responses, treatment options, and overall experiences of pain are influenced by biopsychosocial factors to various extents. Pain perception, expression, and control are progressively learned behaviors among members of a society and are culture-specific. Effects of ethnicity-related culture (ethnoculture) on pain experience in a broader context have increasingly been reported. However, evidence from ethnoculturally diverse groups of a nation, particularly based on surgical patients, is limited. Therefore, as a qualitative research effort of a broader project aimed at assessing ethnocultural determinants of surgical pain management, this study explored the perception of ethnoculturally diverse patients and families about expressing surgical disease-related pain.

Methods

This study follows subjectivist-interpretivist philosophical assumptions as an underpinning research paradigm. We purposively selected 11 patients for in-depth interviews and 12 patients' family members for focus group discussions in three hospitals of ethnic-based regions of Ethiopia. In the phenomenological frame, thematic analysis was employed.

Finding

Ethnocultural background influences how individuals express and respond to pain according to emergent themes of finding- Pain and overlooked cultural influence, Pain expressiveness in cultural context, Stereotypes of pain expressiveness, and Bravehood through stoic response. Pain feelings are commonly hidden where the domestic culture values stoic response to pain compared to ethnoculture where pain expressiveness is encouraged.

Conclusion

Individuals can express and respond to pain differently due to ethnocultural diversity within a nation. Researchers and clinicians should consider cultural context while applying the prevailing one-size-fits-all pain assessment tools among surgical patients of a nation with ethnocultural diversity.

Pain communication in children with autism spectrum disorder: A scoping review

Children with autism spectrum disorder (ASD) experience social interaction and communication challenges and often display repetitive, restricted patterns of behavior, activities, and interests. The concept of pain is regarded as one of the most complex human stressors due to its subjective and personal nature and the influences of multiple internal and external factors. Due to the complexity of this disorder, it remains concerning how children with ASD communicate their pain and how observers (i.e., parents, carers, and health care practitioners) respond to these children's pain communication. This scoping review aimed to identify how children with ASD communicate or express their pain. Ten studies met the inclusion criteria for further data extraction. Through reflexive thematic analysis, two main themes were identified: verbal and nonverbal responses used by children with ASD to communicate their pain that could influence pain assessment and management strategies. This review highlighted that children with ASD utilized various verbal and nonverbal methods to communicate their pain experiences and that these methods differed compared to children without disabilities. Furthermore, this review emphasizes the importance of holistic pain assessment strategies as well as additional pictorial support for children with ASD. This review recommends that future research should focus on understanding how the inclusion of different stakeholders in pain assessment for children with ASD, can contribute to holistic pain assessment.

Pain in the eye of the beholder: Variations in pain visual representations as a function of face ethnicity and culture

Pain experienced by Black individuals is systematically underestimated, and recent studies have shown that part of this bias is rooted in perceptual factors. We used Reverse Correlation to estimate visual representations of the pain expression in Black and White faces, in participants originating from both Western and African countries. Groups of raters were then asked to evaluate the presence of pain and other emotions in these representations. A second group of White raters then evaluated those same representations placed over a neutral background face (50% White; 50% Black). Image-based analyses show significant effects of culture and face ethnicity, but no interaction between the two factors. Western representations were more likely to be judged as expressing pain than African representations. For both cultural groups, raters also perceived more pain in White face representations than in Black face representations. However, when changing the background stimulus to the neutral background face, this effect of face ethnic profile disappeared. Overall, these results suggest that individuals have different expectations of how pain is expressed by Black and White individuals, and that cultural factors may explain a part of this phenomenon.

3D Facial Pain Expression for a Care Training Assistant Robot in an Elderly Care Education Environment

As the elderly population increases, the importance of the caregiver’s role in the quality of life of the elderly has increased. To achieve effective feedback in terms of care and nursing education, it is important to design a robot that can express emotions or feel pain like an actual human through visual-based feedback. This study proposes a care training assistant robot (CaTARo) system with 3D facial pain expression that simulates an elderly person for improving the skills of workers in elderly care. First, in order to develop an accurate and efficient system for elderly care training, this study introduces a fuzzy logic–based care training evaluation method that can calculate the pain level of a robot for giving the feedback. Elderly caregivers and trainees performed the range of motion exercise using the proposed CaTARo. We obtained quantitative data from CaTARo, and the pain level was calculated by combining four key parameters using the fuzzy logic method. Second, we developed a 3D facial avatar for use in CaTARo that is capable of expressing pain based on the UNBC-McMaster Pain Shoulder Archive, and we then generated four pain groups with respect to the pain level. To mimic the conditions for care training with actual humans, we designed the system to provide pain feedback based on the opinions of experts. The pain feedback was expressed in real time by using a projector and a 3D facial mask during care training. The results of the study confirmed the feasibility of utilizing a care training robot with pain expression for elderly care training, and it is concluded that the proposed approach may be used to improve caregiving and nursing skills upon further research.

Hide Your Pain: Social Threat Increases Pain Reports and Aggression, but Reduces Facial Pain Expression and Empathy

Earlier research studying the effects of social threat on the experience and expression of pain led to mixed results. In this study, female participants (N = 32) came to the lab with 2 confederates. Both confederates administered a total of 10 painful electrocutaneous stimuli to the participant. The framing of the administration was manipulated in a within-subjects design: In the low social threat condition the participant was told that the confederate could choose between 10 and 20 pain stimuli, thus they believed that this confederate chose to administer the minimum allowed number of pain stimuli. In the high social threat condition the confederate had a choice between 1 and 10 stimuli, thus they believed that this confederate chose to administer the maximum allowed number of stimuli. Participants reported on the intensity, unpleasantness, and threat value of the painful stimuli, and their facial expression was recorded. Moreover, aggression and empathy toward the confederates were assessed. As hypothesized, participants reported increased pain intensity, unpleasantness, and threat in the high social threat condition compared to the low social threat condition, but showed less facial pain expression. Finally, participants exhibited increased aggression and reduced empathy toward the confederate in the high social threat condition. PERSPECTIVE: Social threat reduces painful facial expression, but simultaneously increases pain reports, leading to a double burden of the person in pain. Additionally, social threat affected social relationships by increasing aggression and reducing empathy for the other.

Capturing patients' symptom expression and spouses' cardiovascular responses continuously: The feasibility of examining a mechanism of disease risk in the home

INTRODUCTION

Spousal caregivers face increased cardiovascular risks; lab studies suggest that autonomic reactivity to patients' physical suffering may play a role. To evaluate this mechanism in daily life, our pilot study characterized the feasibility of recruiting couples for a multimethod, in-home assessment. We examined the usability of the resulting data in an effort to link spousal cardiovascular changes to patient pain expression during couples' everyday interactions.

METHOD

For two 48-hr periods, individuals with rheumatoid arthritis (RA) and their partners wore heart monitors while audio-recordings captured couples' in-home interactions. Interbeat intervals were subsetted in 1-, 2-, and 5-min windows before and after each pain expression. Pre-post difference scores in high-frequency heart rate variability (HF-HRV) and heart rate were examined.

RESULTS

Of the 17 screened RA patients, 11 were ineligible, and 3 partners declined. The 3 participating couples completed all study activities. The resulting 288 hr of recordings were coded for patients' RA symptom expression, which varied from none to an average of 11 times daily. One couple had sufficient data for physiological analysis: Contrary to prediction, spouse HF-HRV significantly increased after patient symptom expression.

CONCLUSIONS

Recruitment rates mirrored other couples studies, and enrolled couples complied with study procedures. In-home conversations were reliably coded and successfully linked to spousal ongoing cardiovascular activity. Preliminary findings highlight the importance of optimal sampling windows and suggest symptom expression as a relevant process for some spouses but not others. We offer recommendations for efficiently scaling up the method in future studies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The psychometric properties of the cervical nonorganic signs in patients with neck pain: an assessment of pain expression

PURPOSE

Neck pain is a common cause of disability. This study investigated the psychometric properties of the cervical nonorganic signs (CNOS), a tool for assessing abnormal illness behaviors in patients with neck pain.

METHODS

The CNOS was administered on patients with neck pain. Reliability and validity analyses were used to evaluate the psychometric properties. Exploratory factor analysis was used to investigate the dimensionality. Correlations with the Short Form-36 were used to investigate the convergent validity.

RESULTS

The results supported the reliability (inter-rater reliability intra-class correlation: 0.920), validity (correlated with body pain (|ρ|=0.31) and vitality (|ρ| =0.30), and two-factor dimensionality (χ²=5.904, p= 0.66; χ²/df = 0.738; RMSEA< 0.001; CFI = 1.000; TLI = 1.024; SRMR = 0.047) of the scale. The two factors were pain (severe pain) and vitality (poor vitality) expressed by the patients.

CONCLUSION

The CNOS is a reliable and valid instrument for assessing pain and vitality problems. It helps patients to express severe pain and lack of vitality. The rehabilitation discipline could use the scale to understand pain expression and to design proper rehabilitation programs. Implications for Rehabilitation The cervical nonorganic signs has two domains (pain and vitality). The scale is reliable and valid for patients with neck pain. Patients with high scores on the pain domain have severe body pain that may interfere with normal social activities. Clinicians should understand their suffering and try to help them to alleviate the pain.

Parental attitudes to children's pain and analgesic drugs in the United Kingdom

Many children experience treatable moderate to severe pain following surgery. Increasingly, children undergo surgery as day cases, and, as such, parents are more likely to be responsible for managing pain post-operatively. Research in the United States and Finland has found parents fear the side effects of analgesics; think they are addictive; and that children should receive as little analgesia as possible. Little is known about parental attitudes in this context in the United Kingdom. This study set out to explore parental attitudes towards children's pain and analgesic drugs to contribute to existing knowledge about parental attitudes elsewhere so that the information provided to parents can be tailored effectively. A convenience sample of parents (n = 108) at one hospital in South West London completed the Parental Pain Expression Perceptions and the Medication Attitudes Questionnaires. Although many parents have a good understanding of the ways in which children express pain, a substantial proportion of parents hold misconceptions regarding how children express pain and concerns in relation to analgesic drugs. This may impact on the quality of the pain management provided to children post-operatively and needs taking into account when preparing parents in this context.