[BLANK_AUDIO]. Hi, we're here today. We're going to have a discussion with Doctor Salimah Meghani. An expert on. Pain, thank you for joining us today. And we've talked some about how pain is a unique experience and it's different from one individual to the next. So today we're going to learn more about why that is. And I know we all have some questions, but I think I'll just get it started by asking you to explain please how social, cultural, or psychological factors can influence pain? >> Sure. So first of all, thank you for having me. I think the question requires digging just a little into the history of pain. So up until 19th century, the dichotomized pain as somatogenic experience. In a psychogenic experience. And we thought of pain as a linear sensory experience. So if Megan and I would be given the same type and intensity of painful stimuli both ought to experience the same levels of pain. And any difference that would occur. Would occur because the pain would be in our heads. So this conceptualization of pain was challenged in 20th century. Of [UNKNOWN] the theory mainly by Melzack and Wall the gate control theory of pain. The International Association for the Study of Pain. In mid 1970's, they, they came out with a new definition of pain. Explaining pain as both a sensory and an emotional experience. So when you talk about an individuals biology, individual psychology, or sociology. I would like to think of them as lenses. Each of them being lenses through which the pain experience is filtered. [BLANK_AUDIO] Any. >> Great. Any other questions or? >> How do social factors influence the pain experience? >> So I think of social factors as the social or ecological factors like environmental factors that affect pain outcomes. The examples of social factors would include an, an individual's income, education, where does this person live, the geographical area. What type of work does this person do? So all of these factors would, would affect pain outcomes one study by Dr. Rash Portnoi and his group, he conducted a nationally represented survey in the US population to understand factors related to disabling pain outcome. And he found that in the visuals with low income individuals, like those earning $25,000 or less are three times more likely to experience disabling pain when compared to individuals with high income, he operationalized it as individuals earning more than $75,000 a year. [INAUDIBLE] So all these factors, broadly, are visualized as socioeconomic realities of an individual, affect pain outcomes. >> Can you explain a little more why you think income would affect how severe somebody's pain is? >> Sure, it's a very good question. So low-income individuals have differential opportunities in the social sec, sector, as compared to high-income individuals. So low-income individuals would be less likely to have healthcare access to begin with. They would be less likely to have continuity of care. They would be, they would be working in, in job settings where they would have to do more manual labor types of work. So all of these factors culminate into the product which is a paying outcome. >> Okay. >> What would be some ways that pay might vary across cultures? Alright this is a very, very good question. Extremely important question so I, I'll start by defining what culture is. So culture is transmission of a set of beliefs or expectations by group membership. So three important points about culture. First of all it is the most misunder, understood. in terms of its influence on pain outcomes. People tend to generalize the effect of culture on pain outcomes. So, for instance, everybody, pertaining in a certain, say, ethnic group would have x type of pain expectations or belief structure. So that, that is absolutely not how one should approach pain. Because there is this trojan lady, even within cultures in terms of how pain is experienced. Because even culture is transmitted or filtered through an individual's lens. Individual's past experiences, their personal histories, you know. so, so that was my second point. The first point being that there are dangerous generalizations on cultural, cu, cultural's influence on pain outcomes. Second being there are vast [UNKNOWN]. In, in pain outcomes even within, or expectations even within a culture. And third an often ignored point is that social factors often shape cultural belief structures. So it could be cyclical. One example I'll give you from my own research. That African americans. And often believed that their pain complaints are not believed by healthcare providers. Or they stereotyped in the healthcare system. So, they tend to be stoic. And there are studies, many studies that have documented that African American patients, and my research pertain to cancer patients and other. Our studies being conducted with cancer patients that African Americans are more, more stoic in terms of seeking pain treatment. One study is done by Dr. Karen Anderson from the Anderson Cancer Center. And she said African American patients would wait until their pain is ten out of ten to get providers in terms of asking for help. So even though somebody could come out with saying oh, African, and there are studies actually, you can find them. With those African American as if you know African Americans or any other ethnic group is being born with these set of belief. But beliefs are also social constructions, they are socially made. Can you, just clarify the term heterogeneity, because I'm not sure we all know what that means. And you used it in regards to the second point that you made. >> Sure. So, I said that it was heterogeneity in, within a culture, in terms of belief structures. And what I mean by that. Is that there is belief structures maybe on an entire continuum. So people may, within a set, within a culture, people may hold different belief structures. So even though you may, may do a study and you may come out and say that x group is more stoic or, or believes in toughing pain out,. But you're talking about on average, findings. On average, but human beings are not what is called measures of central tendency. Like mean, median and bones. So human beings, when you're dealing with personal experience as you, one has to realize that patients may vary an entire range. Ridden that culture in terms of their belief structures. >> So how does, treatment of pain, or lack of treatment affect someone's future subsequent pain experiences? >> That's a very good question. so, we know of acute pain as adaptive, or serving some. Purpose, which is to get us away from a harmful or potentially disruptive external [INAUDIBLE]. Untreated acute pain may become pathological. So chronic pain does not serve any adaptive function but it puts a demand on your psychological reserves, on your social resources. And there are documented changes in the central nervous system as a result of chronic pain which becomes pathological. Now, unfortunately certain drugs, and again I'm using examples from my own research, are disproportionately more likely not to get any great pain relief. My research is being with African Americans with cancer pain, but I conducted a meta analysis synthesizing 20 years of existing data on pain treatment outcomes. And I found that African Americans regardless of the pain treatment setting. Are less likely to receive and these defenses were both statistically significant and clinically significant. Less likely to receive pain medications across treatment settings. >> Are there any universal truths that hold even regardless of social and cultural factors? I think that based on our current, current understanding of pain, I, I, I would say that nonsusception would be [INAUDIBLE] like there is some transmission, you know, along pain pathways. but, [INAUDIBLE] when you take into account the psychological factors, the cultural factors, or, the soci, social factors. I would say that the only homogenous truth about pain experience is that it is heterogeneous. And it should be approached individually for the reasons that we discussed briefly before. >> Thank you. >> Does anybody have any other questions before we close up? Great, well, I think this has been really helpful and eye-opening and allowed us to understand better how factors like income or. Ethnicity might influence somebody's pain experience, so thank you so much for being with us here today. >> Thank you for having me.
