Running head: PRIVATE AND PUBLIC DICHOTOMY OF PAIN 1

Private and Public Dichotomy of Pain

Alyssa Matulich

University of Tennessee Chattanooga

Diversity, Ethical Issues, and Advocacy in Advanced Practice

PRIVATE AND PUBLIC DICHOTOMY OF PAIN 2

Private and Public Dichotomy of Pain

The purpose of this assignment is to gather information from individuals in order to

assess and understand perceptions of pain in public and in private so that we better understand

how pain is expressed. Pain is a universal phenomenon that takes on complexity because it is

influence by one’s personal beliefs, culture, society, and physiological factors (Post, Blustein,

Gordon, & Dubler, 2001). Not only how these factors affect the person expressing pain are

important to understand but also how these factors affect the caregiver and how these two

compare will determine how the pain is treated and managed. As advanced practice nurses

assessing our own values and beliefs regarding pain will ensure that we do not place these beliefs

on our patients in hopes to remain unbiased in our approach to patient care. Because pain is

highly subjective and differs between each individual is important to approach patient care and

pain management with an open mind with a broad understanding other’s expression of pain may

not mirror mine. This assignment helped confirm and strengthen many of my beliefs about

patient expression of pain. Because pain management is such a large and important part of

patient care gaining as much knowledge about others perceive pain will broaden my knowledge

and allow for me to better view pain objectively and through the patient’s eyes.

Method

In order to gain the information needed for assessment, free listing was utilized to

provoke an individual’s thoughts concerning public and private pain. The free listing interview

technique is used to elicit information about a specific topic or domain. Ten individuals were

interviewed using the free listing interview technique. Five men and five women ages 25-35 of

middle socioeconomic status provided their answers in an environment determined by the

individual. Of the respondents seven were Caucasian, one was African American, one was
PRIVATE AND PUBLIC DICHOTOMY OF PAIN 3

Hispanic and one was Asian. Three of the interviews were done in an office setting after work

hours or during a lunch break. One interview was conducted using Facetime technology due to

the individual’s residency in a different state. Six of the respondents preferred the interviews be

conducted in their home residence. Before beginning the process of free listing the, I explained

the process and purpose of the exercise and asked the following questions:

I. “Please provide a list of the kinds of pain that you would expect an adult

male/female should not share with others.”

II. “Please provide a list of the kinds of pain that you would expect an adult

male/female could/would share with others.”

Four respondents asked for clarification on what was meant by “others.” They asked this

question because they stated they would respond differently around family than they would

around other people. One respondent also wanted to know if this was in a medical context like

within a hospital setting with doctors, nurse etc. or in everyday life experiences because his

answers would change based on the situation.

Results

The five female respondents produced a list of 27 items they would not share with others

and would be considered private pain. The top two responses listed were death of a parent or

close loved one and fertility issues/ miscarriages with four responses each. Financial struggles

followed closely behind with relationship problems/ divorce with three responses each. A list of

25 responses was produced regarding pain they would share with others. The most common pain

they would share with others was headache and childbirth with four responses each. Menstrual

cycle pain, limb pain/joint pain, and work-related pains like carpal tunnel or neck pain followed

with three responses each. See Appendix B for visual representation of data.
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The five male respondents produced a list of 20 items they would not share with others

and considered this private pain. The top answer for the men with five responses was death of a

family member or loved one. Closely following were the responses of work-related stress/pain

and relationship failures/pain, with four responses each. For pain that the male respondents

would consider public, a list of 15 items was produced. The top response for public pain was

pain associated with muscles / working out with five responses. The next most common

responses were headaches and abdominal pain with three responses each. See Appendix A for a

visual representation of data.

Discussion

As I expected there were a greater number of responses for the type of pain both males

and females would not share with others. The types of pain that both genders were willing to

share with others were types of physical pain while emotional pains were considered private

pains. I did not find that there was a large difference in pain expression between races but this is

only a small subgroup of individuals and I feel that it is still important to take known cultural

differences in expressions of pain into consideration while an advanced practice nurse. The

results also showed that females were more likely to express pain in general. There were fewer

responses in both categories for men than there were for women which fell in line with my

expectations. I found it very interesting that both males and females included emotional pain in

their free listing assessment. All respondents had previous knowledge of my association with

nursing and I anticipated most of the answers to be associated with physical pain. This exercise

made me think a lot about pain treatment while an advanced practice nurse. We as Americans

tend to vocally express pain especially of the physical nature but it is important to take emotional

pain into consideration. It is also important to assess pain in a private manner as well to make
PRIVATE AND PUBLIC DICHOTOMY OF PAIN 5

sure you are making a full pain assessment. At times, it may be important to ask family members

to step out of the room in order to get a better idea of patient pain that they may not be

comfortable sharing with others. Sheffield et al. (2000) points out that pain perception and

expression are significantly influenced by personality, emotional state, and socialization factors.

Keeping these factors in mind while managing pain as an advanced nurse practitioner will be

key.
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References

Post, L. F., Blustein, J., Gordon, E., & Dubler, N. N. (2001). Pain: ethics, culture, and informed

consent to relief. The Journal of Law, Medicine, and Ethics.

Sheffield, D., Biles, P., Orom, H., Maixner, W., & Sheps, D. (2000). Race and Sex Differences

in Cutaneous Pain Preception . Psychosomatic Medicine, 62.

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Appendix A

Females WouldChildbirth
Not Share with Others
Cancer 4%
Death of parent
7%
15%
Eating Disorder
7%

Fertility Issues
Chronic Illnesses 15%
7%

Mental Health Problems

7%

Financial Struggles
11%
Depression
8%
Menstural Pain Relationship Problem/
8% Divorce
Death of parent Fertility Issues 11% Financial Struggles
Relationship Problem/ Divorce Menstural Pain Depression
Mental Health Problems Chronic Illnesses Cancer
Eating Disorder Childbirth

FEMALES WOULD SHARE WITH OTHERS

Back Pain
8% Headache
abdominal Pain 16%
8%

Foot Pain
8%
Childbirth
16%
Chest Pain
8%

Work related pain Menstural Cycle

12% pain
Limb/joint Pain
12%
12%
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Appendix B

MALES WOULD NOT SHARE WITH OTHERS

Mental Health
problems
10% Death
Fertility problems 25%
10%

Financial
Struggles
15%

Work- Related
Stress
20%
Relationship
failures/ Pain
20%

MALES WOULD SHARE WITH OTHERS

Back Pain

Muscle/ Workout
Pain
Tooth Pain

Abdominal Pain

Headaches