A cross-cultural comparison of adaptation to chronic pain among Anglo-Americans and native Puerto Ricans

Using quantitative and qualitative data from studies in New England and Puerto Rico, we compare the chronic pain experiences of Anglo-Americans and native Puerto Ricans. We also compare adaptation to chronic pain between and within these two groups. Positive adaptation is defined as the process of adjustment in behavior and attitudes which facilitates resumption and continuation of a life defined by the subject as meaningful and worthwhile. Our case studies and quantitative analyses demonstrate that successful adaptation is associated with a reduction in depression, tension, and worry; and the realistic continuation of family, social, and work roles. Our analyses also demonstrate that the factors most often associated with adaptation are cultural (meanings and standards), psychosocial (social support, age, socioeconomic status, psychological coping style), the cultural context of care (providers' world views), and the political and economic circumstances under which compensation and rehabilitation are sought. Our quantitative analyses show significant inter- and intra-cultural group differences in pain intensity and emotional responses to the pain. However, despite higher pain intensity and more emotional responses among Puerto Ricans, there was no significant difference between the two groups regarding interference in daily activities. The two groups simply appear to experience chronic pain differently. We propose that the difference is not positive or negative in itself--it is simply a different reality which should be evaluated from an emic perspective and not through the cultural lens of the outside provider or researcher. Intra-group analyses are essential because they provide insight into the standards, norms, and variations within specific cultural groups.