One challenge many expats don’t anticipate when seeking medical care overseas is how their pain may be misinterpreted. Dealing with pain in a foreign country can be complicated by cultural differences that shape the way pain is perceived and expressed. The result is often a lack of understanding and, therefore, less effective treatment. To better prepare for this reality, let’s explore how culture influences pain, the challenges this creates for obtaining proper healthcare, and how you manage pain while living abroad.
Pain is a universal human experience, but the way it is interpreted and expressed is deeply influenced by culture. A symptom seen as minor or ordinary in one cultural context may be viewed as clinically significant in another.
For example, in Mediterranean countries, openly expressing pain is widely accepted. In contrast, South Asian cultures value restraint and stoicism. A study conducted at the Université du Québec en Outaouais compared Canadian and Chinese participants. It found that East Asians were more often exposed to faces showing pain with higher intensity than Westerners. The reason is that many East Asians tend to withhold visible expressions of pain until it becomes unbearable. Westerners, on the other hand, express discomfort even at lower intensity levels, often using a range of facial expressions.
These cultural differences affect how healthcare professionals interpret pain. The same symptom may be dismissed as “exaggerated” or “understated,” depending on the cultural context.
Cultural bias can lead to damaging stereotypes. In France, for example, doctors have long used the term “Mediterranean syndrome”, a notion first criticized by Martinican psychiatrist Frantz Fanon in the 1950s. There is a common misconception that African, North African, or Caribbean patients have a lower pain tolerance. Their complaints are often labeled as excessive or disproportionate.
The consequences of such assumptions can be tragic. In 2020, Yolande Gabriel, a woman from Martinique living in France, called emergency services while in severe pain and struggling to speak. The doctor on the line dismissed her distress. By the time help arrived, she was already in cardiac arrest and could not be saved.
Expats often face significant barriers when it comes to medical care. Communication is one of the most pressing issues. When describing symptoms in a second language, expats and travelers may lack the vocabulary needed. Pain is often explained through metaphors such as “burning,” “tightening,” “stabbing”, which are difficult to translate. Many end up resorting to vague terms such as “a little pain” or “a lot of pain.”
But since pain intensity itself is perceived differently across cultures, this can create confusion. Doctors may be left uncertain about what the patient is actually experiencing, or they may rely on cultural stereotypes, which increases the risk of misdiagnosis, stigmatization, or inadequate treatment.
Access to pain relief also varies significantly between countries. Medications that are readily available at home may be restricted, or even banned, in the host country. For example, codeine (an ingredient in the commonly used Dafalgan with codeine) is prohibited in Georgia because it is derived from the poppy plant, which is used to produce opium. Two French tourists learned this the hard way when Georgian authorities arrested them for carrying the medication.
Treatment protocols also differ widely. Some countries rely more on physiotherapy, others on traditional medicine, and others on opioids. These variations can make pain management especially difficult for expats.
Fortunately, there are ways to prepare for and mitigate these challenges.
Before you travel :
Prepare a translated medical file that includes your diagnoses, current treatments, and allergies. Learn a few basic medical phrases in the local language, such as “I have a headache” or “I feel nauseous.” Speak with your doctor at home about getting longer-term prescriptions if possible, so you have access to the medications you need.
Once abroad
Use visual pain scales (0 to 10) to help communicate clearly with healthcare providers. If you feel your pain is not being taken seriously, insist politely but firmly. If communication remains too difficult, consider requesting a professional medical interpreter.
Going further
Research the local healthcare system and treatment practices in advance. Seek care at hospitals or clinics recommended by your international health insurance provider.
Awareness of cultural differences and careful preparation can make it easier for expats to receive appropriate pain treatment while abroad.
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One challenge many expats don’t anticipate when seeking medical care overseas is how their pain may be misinterpreted. Dealing with pain in a foreign country can be complicated by cultural differences that shape the way pain is perceived and expressed.
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