Stoic in Japan

An obstetric anesthesiologist flagged this New York Times story for me, noting that Japan's cultural values around pain relief may explain why the country has such a low epidural rate (single digits) compared with high rates here (80 percent in some hospitals).

September 10, 2007
Japanese Slowly Shedding Their Misgivings About the Use of Painkilling Drugs
By DONALD G. McNEIL Jr.
OKAYAMA, Japan — If any nation ought to lead the world in the consumption of painkillers, it is Japan. Its population is aging, and cancer is the leading cause of death. It has universal health insurance, and few restrictions on prescription narcotics. And it is a heavily medicated society; it consumes half the world’s Tamiflu, the anti-flu drug.

Yet, on charts detailing the per capita consumption of narcotic painkillers throughout the world — routinely topped by the world’s richest countries — Japan is down in the neighborhood of Bulgaria and South Africa. It consumes one-twelfth as much per capita as the United States.

The leading reason for that, said Dr. Fumikazu Takeda, a retired neurosurgeon who leads the fight for better pain control, is patients’ fear.

Until recently, morphine was used only in hospitals, and near the end.

“People hate morphine because they think, ‘As soon as the doctor injected morphine, my father died,’ ” Dr. Takeda said.

Also, until recently medical schools taught that narcotics should be used only briefly at low doses.

And some national sense of “gaman” — that suffering in silence is a virtue — persists even in hedonistic modern Japan.

“Long ago, a samurai who complained about pain was considered a very weak samurai,” he said. Young people have other ideas, but with life expectancies over 80, the typical cancer patient is from another generation.

....You can read the rest here: http://www.nytimes.com/2007/09/10/health/10painside.html?_r=1&oref=slogin