Pain Management of Amazon Indigenous Peoples: A Community-Based Study

Abstract

Purpose: Indigenous peoples are vulnerable populations that live in remote areas of the Amazon forest with limited access to health-care services. Underreporting and undertreatment of pain is a common event in the general population but little is known about these issues in indigenous peoples. The aim of this study was to investigate the characteristics and cultural aspects of pain management in five ethnicities of the Brazilian Amazon.

Materials and methods: Cross-sectional study carried out with adult indigenous individuals from five ethnicities of the Brazilian Amazon over two scientific expeditions (June-July/2017 and February-March/2019). Pain assessment included etiology, intensity, duration, aggravating and alleviating factors, body location, impact of pain on activities of daily living, and treatment.

Results: Ninety indigenous individuals with a mean age of 41.42 ± 19.59 years (range 19‒98 years) and median age of 37 years participated in the study. Sixty-four individuals (71.1%) reported experiencing pain at the time of interview with intermittent musculoskeletal pain of strong intensity being the more prevalent (back pain: 45.3%, joint pain: 43.7%) followed by headache (26.5%). The main alleviating factors reported were traditional indigenous medicine (21.0%) and rest (30.0%), and physical exertion was the main aggravating factor (69.0%). Most study participants reported that pain affected their mood, activities of daily living, and sleep and that they used both traditional indigenous medicine (78.0%) and conventional medicine (81.0%) for pain relief.

Conclusion: Musculoskeletal pain is prevalent among indigenous individuals, affects their quality of life, and is partly attributed to their lifestyle. Cultural aspects mediating the pain experience were observed. Traditional indigenous medicine for pain relief remains partially preserved among the ethnic groups investigated. The findings of this study can help improve the delivery care to these vulnerable populations.

Keywords: indigenous peoples; pain management; public health; traditional medicine; transcultural nursing; vulnerable population.

Figure 1

(A) Collection of leaves for ointment production; (B) preparation of ointment from plant extracts with anti-inflammatory properties; (C) extraction of essential oil for headache treatment; (D) preparation of breu-branco (amescla) resin (Protium heptaphyllum) with annatto powder (Bixa orellana) prayed by the shaman; (E) marks of the use of the toxins secreted from glands in the skin of the giant monkey frog Phyllomedusa bicolor (the “toad vaccine” or “kambô” contains opioid peptides with analgesic properties); and (F) nasal snuff inhalation artifacts.