title: "All my tears were gone": suffering and cancer pain in Southwest American Indians.
abstract: BACKGROUND
  Although minority patients with cancer are more likely to be undermedicated for cancer pain than non-Hispanic whites, little is known about the experience of cancer pain in American Indians (AIs).
  
  
  OBJECTIVE
  To describe the experience of cancer and cancer pain in a sample of southwestern AIs.
  
  
  METHODS
  Ethnographic interviews were conducted with 13 patients and 11 health care providers, caregivers, and community members; two questionnaires were used to collect demographic and pain data.
  
  
  RESULTS
  Barriers to pain control among AIs included difficulties describing pain, a belief that cancer pain is inevitable and untreatable, and an aversion to taking opioid pain medication. Prescriber inexperience also was cited as a barrier to pain management. AIs described a strong desire to protect their privacy regarding their illness, and many felt that expressing pain was a sign of weakness. The inability to participate in spiritual and cultural activities caused AIs distress, and some discontinued treatment or missed chemotherapy appointments to engage in these activities.
  
  
  CONCLUSIONS
  Results revealed new knowledge about the cancer pain experience in AIs. The observation of the close relationship between treatment compliance and the patient's ability to participate in ceremonial and spiritual activities provides new insight into the problem of incomplete cancer treatment in this population. The finding that AI patients have a multidimensional conceptualization of pain will assist clinicians with obtaining more detailed and informative pain assessments.
authors.affiliation: University of New Mexico College of Nursing, Albuquerque, New Mexico, USA. ehaozous@salud.unm.edu
authors.forename: Emily Ann
authors.initials: EA
authors.lastname: Haozous
authors.forename: Mary Tish
authors.initials: MT
authors.lastname: Knobf
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology; D005260:Female; D006801:Humans; D007199:Indians, South American / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology*; D010146:Pain / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology*; D015206:Southwestern United States / Q000208:ethnology; D013315:Stress, Psychological / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology*; D016312:Treatment Refusal / Q000208:ethnology / Q000523:psychology