title: Canadian and American self-treatment of pain: a comparison study.
abstract: BACKGROUND
  Adults frequently rely on self-treatment modalities to relieve pain that exceeds everyday kinds of pain, such as minor headaches and toothaches. Examples of self-treatment modalities include doctor-prescribed analgesics, non-prescribed over-the counter medications, herbal substances and treatments, and non-drug treatments such as heat, cold and exercise. Self-treatment is often associated with adverse affects related to the improper use of self-treatment substances and the adverse interactions they may produce when combined with other prescribed or non-prescription treatments for pain control. Many adults also use a variety of self-treatment modalities without informing their health care providers.
  
  
  OBJECTIVE
  To explore the occurrence of pain and identify pain self-treatment modalities used by members (n = 105) of rural communities from two eastern Canadian provinces. Results of this study were compared with a rural American cohort study in order to explore similarities/differences in patterns of self-treatment of pain between the two countries.
  
  
  METHODS
  This descriptive-exploratory study was conducted using a survey method. The design followed that used in a US study by Vallerand, Fouladbakhsh and Templin. Investigators used self-report questionnaires to identify pain self-treatment modalities, pain intensity ratings, pain interference, and the percentage of pain relief in a convenience sample of 105 participants recruited from two Canadian rural communities. Differences in mean scores between Canadian and US data were determined through t-tests. Difference between Canadian and US pain self-treatment modalities were determined using chi2 tests for significance.
  
  
  RESULTS
  Canadians reported choosing significantly more non-pharmacological self-treatment modalities of pain control such as heat, cold, exercise/stretching, and massage than did their US counterparts (chi2 = 7.6, p = .006). US participants reported significantly higher percentages of pharmacologic modalities than Canadian participants, ie prescription medications (chi2 = 4.8, p = .03), and over-the counter medications (chi2 = 8.14, p = .004). There was no significant difference between the two countries in the number of herbal supplements taken for pain relief (chi2 = 2.47, p = .12). Canadian participants reported having significantly less pain relief from their current self-treatment regimen than US participants, (t = 13.77, p = .00). In addition, 33% of Canadian participants and 20% of US participants had not informed their primary care practitioner of their self-treatment choices.
  
  
  CONCLUSIONS
  This study demonstrates that pain is a common experience for many North American individuals living in rural communities. Comparison of results between Canadian and US cohort studies indicate that rural Canadians may benefit from increasing their knowledge about self-treatment options of pain control. Findings showed that rural Canadians choose more non-pharmacologic self-treatment modalities and have less pain relief than rural US participants by their self-treatment choices. In addition, a significant number of Canadian and US participants had not informed their primary care provider of their self-treatment practices. Community healthcare agencies may need to improve the dissemination of information on how to combine both pharmacologic and non-pharmacologic modalities into self-treatment regimens in order to facilitate more effective pain control for some rural communities. Further study is indicated to examine how the differences found in self-treatment practices between Canadian and US cohort studies relate to the differences between Canadian and US culture and healthcare payment systems.
authors.affiliation: School of Nursing, Oakland University, Rochester Hills, MI, USA. rileydou@oakland.edu
authors.forename: C K
authors.initials: CK
authors.lastname: Riley-Doucet
authors.forename: J M
authors.initials: JM
authors.lastname: Fouladbakhsh
authors.forename: A H
authors.initials: AH
authors.lastname: Vallerand