By Laurel White
A new study from a School of Education faculty member sheds light on the unique challenges minority communities face while attempting to seek treatment for chronic pain conditions in the United States.
The study, published in Counselling Psychology Quarterly, found individuals from racial and ethnic minority groups have to overcome steep language barriers and cultural differences in their pursuit of diagnoses and care for their chronic pain.
According to a 2022 study published in PAIN: The Journal of the International Association for the Study of Pain, up to 34% of adults in the United States suffer from chronic pain. “Chronic pain” is defined as pain that persists for at least three months.
Shinye Kim, an assistant professor in the School of Education’s Department of Counseling Psychology, was the lead author of the study. Kim says the analysis sought to gain insight into the lived experiences of culturally and linguistically diverse patients who are grappling with a complex medical condition that even native speakers often struggle to effectively communicate.
“Pain is so subjective, talking about it is hard for anyone,” she says. “If you speak a different language, there are often no direct translations. And when you’re hurting, all of the intellectual words disappear.”
The study conducted and analyzed interviews with 24 individuals from several racial and ethnic minority communities, including Korean, Vietnamese, Spanish, Tagalog, and Amharic language speakers. It found:
- there is emotional strain in second-language communication;
- differences between Eastern and Western medicine can create additional communication barriers; and
- individuals often feel like a burden if they seek a translator during interactions with a health care provider.
The study also outlined several strategies individuals from linguistic minority communities use when interacting with health care providers, including relying on nonverbal gestures and preparing in advance for visits by rehearsing encounters, translating terms, and drafting lists of questions.
Kim says, given the compounding effects of language, culture, and ambiguity on pain diagnosis, individuals from linguistic minority communities are especially vulnerable to misdiagnosis, ineffective treatment, and poorer health outcomes. She also points out many treatments for chronic pain are biomedical and pharmacological, and many prove to be ineffective. She believes that is in part because providers and patients aren’t fully grasping how experiencing and communicating pain is impacted by a combination of biological, psychological, social, and cultural factors. Tests like X-rays and CT scans, which are seen as more “objective,” are also unable to fill gaps in understanding by detecting chronic pain or its intensity.
Ultimately, Kim hopes her research will lead to the creation of pain assessment algorithms that health care providers can use to more accurately evaluate symptoms and create treatment plans.
“My longer-term vision is to support the health care system in better understanding everyone as a cultural being, and understanding how to account for that and treat people more holistically when it comes to pain communication,” she says. “That will help with diagnosis and intervention.”
Kim was the lead author of the paper. Her co-authors were Nguyen Nguyen of Texas A&M University, Hannah Yoo of Texas Tech University, and Ted Bartholomew of Scripps College.
Kim was also the lead author on another recent study, published in the Journal of Pain Research, which found a tool used to measure a patient’s perceived injustice in receiving pain treatment — the Injustice Experience Questionnaire — is effective in comparing perceived injustice between genders and among different racial and ethnic groups.
Kim says validating the questionnaire’s use with those populations will support additional research that seeks to illuminate diverse communities’ experiences with pain care. That study was co-authored by Yuki Shigemoto of the University of Florida.
Read the full Counselling Psychology Quarterly study, “‘I can’t think in English when I hurt so bad’: the phenomenology of racial and linguistic minority chronic pain patients’ experience with pain communication,” here.