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NOTE

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*Thanks to Christine Cahalan and George Mensing for their extraordinary valuable assistance with the literature review and manuscript preparation. We also gratefully acknowledge the contribution of Caroline Rains, without whose tireless and devoted efforts the challenge of writing this chapter could not have been met.

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INTRODUCTION

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The Lord planned to save us from this assigned task by saying, “… Behold, the people is one, and they have all one language; … and now nothing will be restrained from them …,” later in response to perceived arrogance, He said, “… let us go down, and there confound their language, that they may not understand one another's speech. So the Lord scattered them abroad from thence upon the face of all the earth” [Genesis 11:6-81], which is why it is necessary to write this chapter on ethnocultural and gender differences in the pain experience. Since the destruction of the Tower of Babel, clinicians have come to accept that there is a tremendous range of ethnocultural differences in sensitivities expressed in spoken language and behaviors. Also, as will be discussed, there are differences between the genders, with women continuing to struggle for parity with men while appropriately expecting recognition of their differences from men in cognition, affect, and behavior. We hope that the new knowledge and insight provided by this chapter will enable us to advance beyond stereotypes to an increased probability of being able to provide a more accurate diagnosis and prognosis for a given patient. The objective of practitioners of pain medicine is to reduce pain and restore pleasure, consistent with the views of many philosophies, including hedonism and utilitarianism. As noted recently by Greenblatt, “The highest goal of human life is the achievement of pleasure and the reduction of pain.”2 Although pain is thought by many to be on a continuum with pleasure, some continue the ancient tradition of rejoicing in the pain of others, with vestiges still vicariously available in modern pornography.

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Pain, particularly chronic pain (which persists for more than 6 months or beyond the expected time for recovery from trauma or surgery), is associated with a decline in quality of life and increases the likelihood of physical or mental disability and excessive health care utilization.3 A broad array of factors, from genotype to sociocultural forces, contributes to individual pain response.4 Although the primary objective of this chapter is to describe the role of ethnicity and gender in the pain experience of patients, the reciprocal influence of health care providers’ ethnocultural backgrounds and genders on their perception of their patients’ pain plus the related attitudes, beliefs, and behaviors that they bring to treating their patients should not be overlooked.5,6 Such differences can have a significant impact on the quality and appropriateness of pain relief strategies and ethno-specific stereotypical clinical judgments, resulting in overmedication of more emotionally expressive patients or ...

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