Native Americans' Response to Physical Pain: Culture Effects on Help Seeking Behaviors

Background & Purpose:  Native Americans’ health is a continual process of staying strong, spiritually, mentally, physically and socially.  Illness is thought to be a result of an imbalance of body, mind and spirit.  A review of the Literature indicated a segment of authors inferred Native Americans have different biological and/or physiological pain tolerance than other U.S. populations; specifically, Native Americans express themselves differently to their health care providers than members of the dominant culture.  They identified cultural differences and life experiences that resulted in the use of help seeking behaviors that do not reflect the levels of pain experienced accurately.

Methods: This mixed methods research study was conducted over an eight-month period from December 2013-June 2014, to investigate Native Americans’ differences in response to physical pain.  Seventy-five subjects (24 males (32%) and 51 females (68%)) ages 25-84 years (Mean = 55), from 14 tribal nations participated in 30-60 minute, individual face-to-face or telephone interviews. A 16-question survey including open-ended and closed-ended response choices was administered, querying demographics, pain causes, treatment modality utilized, treatment preference (Western or cultural traditional), activities of daily living (ADL), and help-seeking behaviors. The Universal Pain Assessment Tool, a highly regarded research instrument to assess pain levels was used.   Closed-ended questions were analyzed using SPSS, and open-ended responses were coded into NVIVO and analyzed for themes.

Results: All participants were living with some level of pain, had methods of self-care, and 34 (45%) had limitations of ADL’s (i.e. walking, sleeping, eating, bathing, participating in cultural events, social activities). The majority of participants lived bi-culturally (N=52, 69%); others chose assimilation into Western mainstream culture (N=11, 15%); while a small number lived the traditional ways (N=7, 9%).  The participants are seeking ways to heal, either Westernize modern medicine or cultural traditional healing, or both.  Still some are attempting to heal themselves with their own methods, such as prayer, smudging, meditation, and participation in ceremonies.  Due to cultural grounding, many participants preferred traditional healing.   Less than half of the participants (N= 30, 40%) followed a mainstream physician’s medical advice. Many shared their reasons for not seeking Westernized treatments for pain, such as poor communication by health professionals, prescribed medication did not work, and a desire to use self-care methods.  This refutes the presumption of some authors who report Native Americans require less medication to manage physical pain.

Conclusions & Implications: This study provides non-Native health professionals insight into the care of Native Americans who seek pain management assistance.  Professionals must recognize the role of cultural traditional healers and validate this type of treatment modality in the healing process.  Native Americans feel pain no differently than other populations, but cultural ways and/or historical experiences have had an impact on how they expressed their experience of pain.