Cancer Pain among Southwest American Indians

Across all cancer types, one of the most common and feared symptoms among individuals with cancer is pain. Although cancer is the second leading cause of mortality among American Indians (AI) over age 45, few studies have examined the cancer pain experience within this population. The purpose of this study was to describe from the perspectives of Southwest American Indians with cancer their experiences with cancer pain and barriers to effective pain management. Using Kleinmann's explanatory model to create a dialogue about cancer symptoms, face to face interviews were conducted with 17 Southwest American Indians with cancer. All interviews were audiotaped and transcribed verbatim. Analysis used grounded theory techniques to identify major categories in the data. Participants described pain in terms of common characteristics (intensity, location, timing) as well as in broader cultural terms. Pain was experienced prior to diagnosis, during treatment and some described persistent pain following treatment completion. Although reported pain burden was high among many respondents, themes related to stoicism and “not wanting to give in to pain” were evident. In addition to frequently described pain management barriers (side effects, fear of addiction) other unique situational barriers were described by participants. Financial concerns and self- perceived role expectations contributed to less than optimal pain relief among some participants. Self-management of pain incorporated broad strategies that addressed physical, psychosocial, cultural and spiritual aspects of pain.