RT Journal Article SR Electronic T1 Expression of pain among Mi’kmaq children in one Atlantic Canadian community: a qualitative study JF CMAJ Open FD Canadian Medical Association SP E133 OP E138 DO 10.9778/cmajo.20130086 VO 2 IS 3 A1 Margot Latimer A1 G. Allen Finley A1 Sharon Rudderham A1 Stephanie Inglis A1 Julie Francis A1 Shelley Young A1 Daphne Hutt-MacLeod YR 2014 UL http://www.cmajopen.ca/content/2/3/E133.abstract AB 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. Interpretation 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.