Pain in the ageing population often represents challenges to health care professionals. There are a number of reasons for this; for example, assessment of pain can be challenging, assessment tools may be confusing or seem abstract to the older person. If we consider the visual analogue scale as an abstract example which can be difficult to interpret. Language may be challenging, pain can be a difficult phenomenon and often we need to apply colloquial language such as “sore” or “bothering”. If we add issues around cognitive decline or dementia, many of the typical pain assessment tools are inappropriate and if we consider tools such as Abbey or Doloplus specifically developed to identify pain in people with dementia, they can be time consuming to complete and require training to be applied appropriately. Management is often difficult due to poor understanding, lack of financial resources or many contraindications linked to multiple comorbidities that may exist in this population. Furthermore many of the drugs that we use to manage pain have been evaluated in younger populations and simply translated across which results in side effects and inappropriate dosing or monitoring. The typical factors which influence pain perception also apply to the older group such as age, gender and social influences. But even more significant are the myths and misconceptions which exist amongst health care staff and the older person themselves. Things like “pain is to be expected at my age” or “its your age” are often held beliefs along with fear of prescribing and administering drugs due to the risks. All of these factors have been well researched in the literature although less so with older adults. But what we are not so clear about is the cultural barriers that we see associated with various cultural groups or religious influences. This proposal aims to bring together papers from the various cultures from across the world and highlight the important factors which influence how older adults experience their pain and how health care professionals from each of these differing cultures respond to pain in their patient group. As we see the ageing “time bomb” coupled with the increasing multicultural populations, it is the responsibility of health care professional to ensure care is delivered according to the individual needs of the patient. So an awareness of these cultural influences brought together in this special edition will contribute to improving that knowledge and subsequent care.

Goal

Assessment and Management of pain in the older population has been largely overlooked in the research. Whilst it is improving with the recognition that the ageing population is increasing significantly, there is still much more to be done. We can learn from other cultural groups how assessment and management of pain can be addressed and we can take on board some of the key recommendations. For example the use of acupuncture successfully applied in China and many other countries and technological approaches used in more rural areas. This publication aims to bring together perspectives from across the world which encompass the religious or cultural beliefs of different societies. In one collection we can learn from eachother how these influences may shape pain assessment and management in different countries. But also setting the agenda for the gaps where more research needs to be done. This cultural focus in pain and ageing has not been addressed before but the timing is right as we move forward with our ageing societies.

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Background

In 1952 Mark Zborowski highlighted the variation which can be seen in how people experience their pain due to cultural and/ or religious influences. Age-related and gender related factors have received attention in the research and literature. But very little has been dedicated to the cultural factors which are prevalent in different societies across the world. This collection of papers aims to bring together authors from across the five continents to present the work being carried out focussing on cultural beliefs and how they influence assessment and management of pain particularly in the older populations. But also, highlighting how these cultural and or religious factors influence how patients respond to their experience chronic pain and report their pain to the health care providers, how we identify and measure the pain and importantly how management is applied and accepted. Thus highlighting differences and commonalities from across the world, lessons that can be shared and gaps where research needs to be carried out.

Scope and information for authors

We are looking for papers which focus on research and evidence from clinical practice from many different countries. The evidence will have explored the factors which influence how assessment and management of pain has been applied taking into account the socioeconomic and political factors which can be influenced by the culture within each country. The implications for care delivery, but importantly the beliefs which are held by the older population which influences their reports of pain and how they respond to treatment approaches. Bringing this research and evidence together can influence the agenda for the future

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Cultural Diversity in Pain and Ageing