Patients and health professionals bring their own cultural attitudes to the communication and interpretation of the patient¡¯s pain experience.

In this interaction, it is the health professional¡¯s knowledge and attitudes that dominate the response to the patient¡¯s experience of pain. In Saudi Arabia, a multicultural foreign and local health care team is challenged to understand the cultural beliefs and attitudes toward pain of both patients and team members.

 To increase cultural understanding and knowledge, a collaborative inquiry project using a culturally diverse group was conducted to learn about cultural attitudes and beliefs on the causes, treatment, and experience of pain.

When the pain comes on with every movement, and the pain in the patient's mind means that his back has been damaged further, several things then happen:-

• The patient becomes frightened to do anything that may cause the pain - this is called Pain Avoidance Behaviour or fear of the pain.
• He anticipates the pain before he moves, causing him to hold his breath and guard his back, whilst tightening his back muscles - this is called Guarded Movements. Guarding only serves to increase the pain during movement, as most of the pain is muscular in the first place.
• Anxiety and depression develop over time with a tendency to catastrophise about the pain, its cause, and its consequences (to make it seem worse than it actually is, to make the pain into a catastophe). Anxiety and depression may also cause the patient to misinterpret the severity of the pain leading to a vicious spiral downwards.

Attitudes, and Beliefs about Pain and AnalgesiaGeneral Household Survey in Texas  Results:

Of the 503 adults who participated in this study, half were female,
53% were white, 28% were Latino, 12% were black, and 39% were 31-50 years of age. Fifty-one percent of respondents indicated that they experience pain monthly, and of these people, 43% have pain everyday, 55% have had pain for at least three years, and 63% have moderate to severe pain.

Consequences of pain included sometimes feeling anxious, irritable or
depressed (66%), loss of sleep (61%), negative effect on relationships with loved ones and friends (35%), inability to dress myself, drive a car, or go shopping (34%), and feeling hopeless and alone (29%). The most common sources of pain among study participants were arthritis (30%), back pain (23%), and muscle pain (10%). While 57% of persons with pain had sought care, common reasons for not seeking pain included a lack of understandingthat untreated pain could worsen (75%) or that pain should be treated as a separate condition (71%), fear of the underlying cause (67%), belief that pain is just a normal part of life (59%), did not know where to go for help (58%), and fear of addiction, embarrassment, or did not want to complain (57%).

Furthermore, only 60% of study participants were very confident that their pain would be properly assessed and promptly treated.