The findings are published in the thesis, ‘Cross-cultural differences in patients with temporomandibular disorders-pain’, written by Mohammad H Al-Harthy. It is hoped that the thesis will aid the treatment of patients in an ever-globalised world.
Different cultures and their experiences of pain
The main idea behind the research was to gain a better understanding of the cultural differences in some issues relating to pain, particularly orofacial pain, which is felt in the jaw, mouth and face - prevalence varies from country to country.
The research was carried out on patients who had reported cases of the oral condition, chronic temporomandibular disorders-pain, in Sweden, Saudi Arabia and Italy. In total 122 women cases from the three cultures answered questionnaires and underwent clinical examination along with a matching gender and age control group of healthy participants of each respective culture.
Consisting of four parts, the first set out to explore the prevalence of temporomandibular disorders in the Saudi dental patients. Another paper sought to compare the three cultures regarding experimental pain.
“We used mechanical/pressure and electrical stimulation with special devices. It gives a signal to first measure pain threshold – the point where you first feel pain - and then another measurement for tolerance - how much pain you can withstand,” explained Mohammad.
Another of the papers looked at comorbid pain, where the orofacial pain occurs simultaneously with pain elsewhere in the body.
“We have explored four chronic pain conditions: back pain, head pain, chest pain and stomach pain. So we asked if they had experienced any such pain in the last six months. The base condition was orofacial pain, so for those with that condition we looked for other conditions to see if they suffered from those pains together at the same time.
“After that we looked at the pain intensity and how it affects the individual and to what extent it affects them, maybe they cannot do their daily work or activity or need to take sick leave.”
The final paper concentrated on the beliefs of patients and about the type of treatment and the type of practitioner that they would visit if they have orofacial pain.
“Whether it be a dentist, a physician doctor, psychotherapist, physiotherapist or a church and someone of religion, we asked where they went first before they came to the specialist clinic.
“After that we gave them a questionnaire with about 30 different kinds of treatment: acupuncture, painkillers, antidepressants, Islamic medicines and other therapies. We asked them what they believed were factors which contributed to their problem. Then we asked them which factors they thought were more aggravating and how much they thought these factors should be taken into consideration when managing the problem.
Swedes could tolerate pain better, and for longer
“Overall we found that in Saudi Arabia the prevalence of temporomandibular disorders-pain was quite high, regarding the pressure experiment, we found that Italians are very sensitive and their threshold is very short - just from the start they feel pain and they cannot tolerate more pain after that threshold. The Swedes were vice-versa, they could withstand more and for longer.
“Physiologically we are all the same, we have the same muscles, the same nerves, the same circulation, but we are thinking as researchers that culture might affect this.”
The research, carried out part-time, took around eight years to complete, not including a six-month period to ensure the accuracy of the translations and cultural adaptation process for the questionnaires from English to each of the three languages.
Treating patients in a globalised world
“This research will draw attention to the cultural background of the patient, particularly now in an era of globalisation and increased immigration rates from the Arabian countries in the Middle East to Europe. In Sweden there are people from many other countries, the same as in Italy, the UK and in America, for example. Now it is common to find different cultures in the same country.
“Say you are a doctor sitting in your clinic and a patient comes to you, you can look at their background and take that into consideration. You can look at the bigger picture in order to manage them better.
“Many doctors are prescribing millions of tablets and capsules without the benefit of that knowledge, so maybe part of that failure is not understanding cultural backgrounds.”