Systematic Review of Pain Research Among Limited English Proficiency Patient Populations in Health care.
Maichou Lor, Shoua Xiong, Nancy B Yang and 1 others
PMID 38104018WHAT IT FOUND
Limited English proficiency patients receive less pain medication and have worse outcomes than English speakers.
Consistent interpreter use improves pain control and satisfaction. Nurses should use culturally preferred pain scales, such as the Wong-Baker Faces for Hmong patients, and ask patients for their assessment preferences.
Key findings
01Patients with limited English proficiency are less likely to receive opioid prescriptions and receive lower doses despite higher injury severity.
02Always using an interpreter is associated with better pain control, more timely treatment, and higher patient satisfaction compared to not using one.
03Pain assessment preferences vary by culture: Spanish-speaking patients prefer word descriptor or numerical scales, while Hmong patients prefer the Wong-Baker Faces scale.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only 25 studies, most of which were descriptive rather than experimental. The search was limited to English-language publications, potentially missing relevant studies. Cancer pain and pediatric pain were excluded, limiting generalizability to those groups. The authors note that language and culture are intertwined, but the review focused only on language barriers, not how culture specifically impacts outcomes independently of language. There is a lack of research on triadic communication (patient-interpreter-provider) and social determinants of health.
Declared interests
The authors declare no conflicts of interest or competing financial interests.
The easy way to misread this
Do not assume that a patient's low reported pain score means they are not in pain. Cultural differences in expressing pain, such as the Hmong view that crying is a weakness, or language barriers that prevent accurate description, can lead to underassessment and undertreatment. Always verify pain levels using the patient's preferred communication method and an interpreter if needed.