title: Expression of pain among Mi'kmaq children in one Atlantic Canadian community: a qualitative study.
abstract: BACKGROUND
  First Nation children have the highest rates of pain-related conditions among Canadian children, yet there is little research on how this population expresses its pain or how and whether the pain is successfully treated. The aim of this study was to understand how Mi'kmaq children express pain and how others interpret it.
  
  
  METHODS
  We conducted a qualitative ethnographic study in a large Canadian Mi'kmaq community using interviews and conversation sessions. Participants included children and youth (n = 76), parents (n = 12) teachers (n = 7), elders (n = 6) and health care professionals (n = 13).
  
  
  RESULTS
  Interpretive descriptive analysis was used and themes regarding pain expression, care seeking and pain management were identified. Pain expression included stoicism and hiding behaviour, and, when pain was discussed, it was via storytelling and descriptive language, such as similes. Participants reported feeling unheard, stereotyped and frustrated when they sought pain care. Frustration led to avoidance of seeking further care, perceptions of racism and repeat visits because of unsuccessful previous treatment. Participants voiced concerns about the utility of the numeric and faces pain scales to describe pain meaningfully. Positive encounters occurred when participants felt respected and heard.
  
  
  CONCLUSIONS
  Mi'kmaq children are stoic and often hide their pain. Community members feel frustrated and discriminated against when their pain is not identified, and conventional pain assessment tools may not be useful. If clinicians consider cultural context, build trust and allow for additional time to assess pain via storytelling or word descriptions as well as a family-centred approach, better pain care may occur.
authors.affiliation: Faculty of Health Professions, Dalhousie University, Halifax, NS ; Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS.
authors.forename: Margot
authors.initials: M
authors.lastname: Latimer
authors.affiliation: Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS.
authors.forename: G Allen
authors.initials: GA
authors.lastname: Finley
authors.affiliation: Eskasoni Community Health Centre, Eskasoni, NS.
authors.forename: Sharon
authors.initials: S
authors.lastname: Rudderham
authors.affiliation: Unama'ki College, Cape Breton University, Sydney, NS.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Inglis
authors.affiliation: Eskasoni Community Health Centre, Eskasoni, NS.
authors.forename: Julie
authors.initials: J
authors.lastname: Francis
authors.affiliation: Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS.
authors.forename: Shelley
authors.initials: S
authors.lastname: Young
authors.affiliation: Eskasoni Community Health Centre, Eskasoni, NS.
authors.forename: Daphne
authors.initials: D
authors.lastname: Hutt-MacLeod