Cultural tailoring of pain management approaches: a scoping review

Pain affects an estimated 1.5 billion people globally. Cultural factors strongly influence how pain is perceived, communicated, and managed. However, it remains unclear to what extent, how, and for whom pain management approaches have been culturally tailored, and whether these adaptations have been evaluated to ensure cultural relevance and effectiveness. This scoping review addresses this gap.

We searched six electronic databases for peer-reviewed articles and grey literature, combining terms for pain and cultural tailoring. We included empirical studies (including protocols), published in English, that reported on the cultural tailoring of pain management approaches for adults (≥18 years). At least two reviewers independently screened titles and abstracts, followed by full text assessment. We charted data on study characteristics, cultural tailoring methods, and evaluation strategies, and synthesised results narratively.

Our search identified 4,551 unique studies, of which we included 38. Of these, 32 (84%) were published after 2016, with 26 (68%) focusing on musculoskeletal pain. They reported the cultural tailoring of 27 unique pain management intervention approaches, of which 19 (70%) focused on racial and ethnic minorities mainly in high-income countries. Educational interventions were most commonly tailored (n = 9, 33%). Only four (15%) tailored approaches were delivered digitally. Most (n = 25, 93%) approaches underwent content adaptation through including culturally relevant language, metaphors, and gender considerations. Most employed early tailoring steps, such as information gathering (85%) and preliminary adaptation design (93%). Only six (22%) approaches used frameworks to guide the adaptation such as Intervention Mapping-Adapt, FRAME, and ADAPT-IT. The effectiveness of cultural tailoring was evaluated for 11 (41%) approaches, mainly through randomised controlled trials (n = 7, 26%).

This review identified several efforts to culturally tailor pain management approaches, particularly for racial and ethnic minorities with musculoskeletal pain in high-income countries. Most tailoring focused on content adaptation for in-person formats, with limited use of contextual modifications, digital delivery, or adaptation frameworks. Future research should broaden tailoring beyond content changes, make greater use of digital tools, and prioritise adaptations in low- and middle-income countries. Evaluation strategies should also expand to assess real-world implementation, and long-term outcomes.