Concepts Within the Chinese Culture That Influence the Cancer Pain Experience

Lih-Mih Chen, RN, PhD; Christine Miaskowski, PhD, RN, FAAN; Marylin Dodd, PhD, RN, FAAN; Steven Pantilat, MD


Cancer Nurs. 2008;31(2):103-108. 

In This Article

Implications for Nursing Practice

The effective management of cancer pain involves a detailed pain assessment, the diagnosis of the cause of the pain, and the development and implementation of a pain management plan. In most cases, a detailed pain assessment focuses on an evaluation of the description, location, and severity of the pain, as well as aggravating and relieving factors, the impact of pain on mood and function, and previous treatments and their effectiveness. Less attention is given to the sociocultural dimension of the pain experience and its impact on the pain management plan.

For Chinese patients, their cancer pain experience may be part of the fabric of their being. Their views about pain and its treatment may be deeply rooted in philosophical and religious beliefs that will impact all aspects of pain assessment and management. These 3 major philosophical and religious beliefs are not separate entities. They interact and fuse in Chinese patients' lives.[29] As part of the assessment of a Chinese patient with cancer, it is important to evaluate the meaning that pain has in the person's life and the causal attributions that the individual gives to his or her pain. In addition, the philosophical approach that a patient has toward whether pain should be treated will need to be discussed before a pain education program and a pain management plan can be implemented.

Chinese patients may believe that pain is caused by a Yin and Yang imbalance in the body. Therefore, they may prefer to take Chinese medicine or use acupuncture, instead of analgesics, to cure the block in the meridians.[30] If clinicians do not understand these beliefs, they may view these patients as not adhering to their analgesic regimen. Furthermore, Chinese patients may believe that the nonharmonic situation between them and the environment (time, place, or others) can cause disease or symptom.[31,32] Therefore, they may use various rituals to enhance harmony (eg, move some furnishings, ask clinicians to perform procedures at a specific time, and refuse visitors who are foes to them). If clinicians do not understand that these rituals are intended to enhance harmony, they may misinterpret them.

Clinicians need to understand that Chinese patients may believe that pain should be endured. Based on a variety of beliefs (eg, sin from last life, the Inn and Ko [cause and effect], a trial or sacrifice, a born-to-be fate, and afraid to bother either family or clinicians), Chinese patients tend to bear and accept their pain. They report pain only when it becomes unbearable.[30,32] Some patients may choose to endure intractable pain to accomplish their life trial. Clinicians need to discuss this belief with patients. They need to inform patients about the deleterious effects of unrelieved pain on their mood and functional status. In some cases, clinicians may need to support the patient's belief system and assure them that they will be available to assist with pain management.

Some Chinese patients may blame themselves for their illness,[33] whereas others may negotiate with God(s) to change their fate by praying in the temple or at home, intonating gospel, giving alms to the poor, becoming a vegetarian, or wearing a Fu (amulet).[31,32] Again, clinicians need to ask patients to describe the various approaches that they use to manage their pain and their illness.

Clinicians need to be patient and encourage Chinese cancer patients to report their pain. They need to explore their beliefs about pain and respect their rituals for pain relief. Patients should be assisted to keep the harmony between themselves and their environment. Clinicians need to discuss with patients which pain management strategies they can accept and use. Finally, patient education programs need to be tailored to incorporate some of the culturally specific approaches to pain management that are outlined in this article.


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