Ateneo de Zamboanga University

College of Nursing

Effects of Sociocultural Factors on the Preference of

Non-Pharmacological Acute Pain Management of
Zamboangueño, Tausug, & Bisaya AdZU
Grade 12 STEM SHS Students

Researchers:

Pastor, Charisma E.

Renolla, Clouise Junice B.

Reyes, Richelle Mae F.

Sahali, Jorgee S.

Sanaani, Nur-Hathi M.
 TABLE OF CONTENTS

Chapter 1: INTRODUCTION

Background of the Study……………………………………………………………………….1

Statement of the Problem……………………………………………………………………...4

Significance of the Study……………………………………………………………………….5

Scope and Delimitation…………………………………………………………………………7

Definition of Terms………………………………………………………………………………8

Conceptual Framework……………………………………………………………………….11

Chapter 2: REVIEW OF RELATED LITERATURE

Foreign Studies………………………………………………………………………………...12

Local Studies…………………………………………………………………………………...34

Chapter 3: METHODOLOGY

Research Design.…………………………………………………………………………...…38

Sampling Design.………………………………………………………………………………38

Research Instruments…………………………………………………………………………39

Research Locale……………………………………………………………………………….39

Ethical Consideration.…………………………………………………………………………39

Participants……………………………………………………………………………………..40

Data Gathering Procedure.…………………………………………………………………...40

Data Analysis.………………………………………………………………………………….41

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Chapter 4: RESULTS AND DISCUSSION

The preference of AdZU Grade 12 STEM students per ethnic group on drug versus non-

drug options as an initial response to

pain…………………………………………………...43

Factors influencing preferred non-pharmacological pain management (NPM)…………66

Chapter 5: SUMMARY OF FINDINGS, CONCLUSION, & RECOMMENDATION

Summary of Findings………………………………………………………………………… 69

Conclusion……………………………………………………………………………………...71

Recommendation………………………………………………………………………………73

LIST OF APPENDICES

Appendix A - Sample Letters ...………………………………………………………………75

Appendix B – Survey Questionnaire…………………………………….…………………..77

REFERENCES…………………………………………………………………………………82

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 Chapter 1

INTRODUCTION

Background of the Study

Zamboanga City is a leading urbanized city located south of the Zamboanga

Peninsula, Region IX. Based on the 2000 Census of Population and Housing by the

National Statistics Office (now known as Philippine Statistics Authority), the three major

ethnic groups of the city are (1) Zamboangueño -- 45.5%, (2) Tausug -- 16.4%, and (3)

Bisaya -- 12.2%. Other ethnic demographics include Samal, Yakan, Tagalog, and

Ilonggo.

According to the Philippine Statistics Authority (2016), the city is known to have

an annual population growth rate of 1.21%, with an aggregate of various ethnicities

reckoned by historical accounts of migrants from neighboring regions. With the diverse

cultural identities in the city, the population has distinctive cultural traditional ways of

healthcare from home remedies to traditional healings to treat pain. Zamboangueños,

Tausugs, and the Bisaya may also have varying priorities that dictate health practices.

In an international study, “Chronic pain management by ethnically and racially

diverse older adults: pharmacological and nonpharmacological pain therapies” by

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Hooyman, N., Manotas K., and Park, J. (2013), the researchers conducted semi-

structured interviews with 44 community-dwelling older adults of different backgrounds.

This study retrieved comparative results wherein ethnic minority groups, African

Americans, Hispanics, and Afro-Caribbeans preferred religious coping, culturally based

treatments, such as herbal tea and avocado leaves; home remedies and folk medicine;

and psychological therapies such as distraction and relaxation. On the other hand, non-

Hispanic whites preferred massages and chiropractic interventions.

Likewise, the researchers propose a study to investigate the preferred non-

pharmacological pain interventions of three ethnic groups in Zamboanga City: the

Zamboangueños, Tausugs, and Bisaya. Common traditional healing practices identified

in Zamboanga City include sahuma (mangtatawas), subada (hilot), and herbalism

(Esperat et al., 2020). These are non-pharmacological treatments that the sick seek to

approach as an alternative to modern medicine. The choice of traditional healing

procedures or other non-pharmacological interventions such as acupuncture, yoga and

meditation, hot and cold compresses, and aromatherapy depend on the sociocultural

backgrounds of patients. Other than using it for severe illnesses, it can be practiced for

milder conditions such as acute pain.

American Academy of Family Physicians (2020) states that there are various

social and cultural factors that influence one’s health are also known as ‘social

determinants of health.’ Examples of these determinants include access to healthcare,

nutritious food, and safe water, socioeconomic status, spiritual/religious values, family

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and social support, and ethnicity and cultural lifestyle. Comprehension of these factors

is essential to promote self-awareness and health-seeking behaviors and practices.

Furthermore, the researchers also intend to study the correlation of sociocultural

factors on preferences of a certain non-pharmacological pain intervention of an ethnic

group. The researchers have selected this research proposal topic as influenced by

Related Learning Experience both in community and hospital that enables them to

handle patients of various sociocultural backgrounds. Zamboanga City health care

delivery systems cater to numerous and a culturally diverse population.

Unfamiliarity to such cultural differences creates a communication gap between

the nurse-patient interactions that may hinder the delivery of holistic care plans.

Awareness of the uniqueness of each culture can inhibit the disposition of personal

biases and establish rapport effectively. Hence, it is part of a nurse’s skills to be

culturally competent to render individualized care by respecting autonomy. This not only

addresses their patient needs but uplifts their cultural identity as well.

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Statement of the Problem

This research aims to investigate the preferred non-pharmacological pain

management of three ethnic groups in Zamboanga City: the Zamboangueños, Tausugs,

and Bisaya regarding different types of acute body pain. The researchers will

emphasize the relationships between specific sociocultural influences and specific non-

pharmacological approach to pain management. Furthermore, this study aims to answer

the following questions:

1. How many AdZU Grade 12 STEM students per ethnic group prefer non-

pharmacological management over analgesics as an initial response to pain?

2. Which ethnic group prefers non-pharmacological pain management the most?

3. What are the common non-pharmacological pain management preferred by the

Zamboangueño, Tausug, and Bisaya AdZU Grade 12 STEM students for:

a. Headache/Migraines

b. First-degree (mild) burns

c. Bruises

d. Muscle cramps

e. Back pain

f. Stomach Ache/Abdominal pain

g. Dysmenorrhea

4. What sociocultural factor mostly influences the choice of a specific non-

pharmacological pain treatment for the given type of body pain?

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Significance of the Study

The Community

This research can be a source of knowledge with regards to the

nonpharmacological methods of managing acute pain. This study generally promotes

health and wellness of the community, and it signifies different sociocultural preferences

of treating acute pain. The study can locally promote various alternative techniques

which can be applied in the community health care field. This includes the inexpensive

and accessible procedures that also help avoid adverse effects from taking medications.

This study can also raise peoples’ awareness in line with the spiritual, cultural, and

social influences of pain management. Through this, the citizens can be able to assess

skills and knowledge of handling acute pain non-pharmacologically.

Clinical Instructors

The study can benefit the clinical instructors wherein it provides information that

can evaluate the health care delivery system of managing acute pain. The study can be

a reference for learning and teaching purposes. It also leads clinical instructors to

formulate efficient strategies to widen the knowledge of the students in a non-medical

treatment approach. The study can also enhance the general behavior, skills and

knowledge in transcultural care. Correspondingly, the clinical instructors will be guided

to improve medical students in valuing patients’ sociocultural beliefs and practices. It will

also improve relationships between patients with respect to cultural diversity.

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Clinical and Student Nurses

The research findings can be able to enlighten clinical and student nurses on the

sociocultural factors affecting the choice of non-pharmacological methods in acute pain

management. It enables them to implement alternative health care procedures at home,

school, community, and even at hospitals. Without the use of acute pain medications,

clinical nurses can critically think of an effective strategy to ease the pain sufferings.

Moreover, it can also improve behaviors concerning transcultural nursing. The study

develops sensitivity and consideration among the patients’ sociocultural needs and

preferences. Clinical and student nurses can also improve health care services that are

acceptable to the family’s cultural background.

Community Health Nurse

This research will provide an alternative solution to community health nurses in

providing supportive care to clients within the community with respect to each cultural

belief system. In addition to that, the community and public health nurses can also

formulate health education programs from this study, specifically for patients living in the

rural region which typically prefers non-medical procedures in line with religious, social

and financial influences.

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School Nurse

The study can benefit school nurses in understanding the sociocultural relation of

pain and its possible ways of alleviating it. Considering not to violate the students’

dignity can be done by avoiding possible taboos that are considered by respective

cultures.

Future Researchers

This research is beneficial for the future researchers wherein it can be used as a

reference data in conducting a new study. This can guide researchers who have similar

range of interest in the field of health. The research process can be used to evaluate

research plans and overview predictions of the study. Concepts and ideas presented

can also be used for citation as a related learning of literature, or for further case

analysis.

Scope and Delimitations

The coverage of the study concentrates on the quantitative data obtained from

the respondents. A sample size with 95% confidence level is calculated out of the entire

population of AdZU Grade 12 STEM students. Stratified random sampling is utilized by

dividing the sample into three groups: Zamboangueño, Bisaya, and Tausug.

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 The types of pain identified by the researchers are as follows:

headache/migraines, bruises, first-degree burns, muscle cramps, back pain,

stomachache/abdominal pain, and dysmenorrhea. The non-pharmacological

managements in this study encompass acupuncture, yoga and meditation, prayer,

tawal-tawal, breathing exercises, hot and cold compresses, distraction, rest/sleeping,

massage, aromatherapy, and herbalism.

Any variation of pain and nonpharmacologic management other than these are

not included in the scope of our study. The limitation of our study is the exclusion of age

that is not within the range of 16-20 years old. Hence, the primary target of this study is

the late adolescent age group.

Definition of Terms

● Acupuncture - a form of treatment that involves insertion of thin needles in a

person’s skin at certain points of the body to relieve pain.

● Acute pain - a sudden onset of mild or severe pain experienced by the

participants, caused by something specific that usually lasts less than 3 to 6

months and disappears when the underlying cause is treated.

● Analgesics - drug medication that participants use to reduce or provide relief from

pain; painkillers.

● Aromatherapy - a healing treatment utilizing natural and aromatic plant extracts

or essential oils to promote health and well-being.

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● Back pain - a pain felt in the back.

● Breathing exercise - a therapeutic exercise in which the participants perform

rapid shallow breathing or slow deep breathing to promote effective breathing,

lower stress levels, and improve blood circulation.

● Bruises - an injury appearing as an area of discolored skin on the body, caused

by a blow or impact rupturing underlying blood vessels.

● Cold compress - a technique the participants may use to cool an injured area,

which protects body tissue by slowing metabolic rate and reducing swelling

around the injury.

● Cultural Traditions - refers to lifestyle including norms and habits of the

respondents in accordance with their ethnic identity.

● Distraction therapy - a treatment in which participants use pleasing sensory

stimuli to help cope or divert the attention from a pain, such as music, arts,

reading, and other hobbies.

● Dysmenorrhea - medical term for painful cramps during menstruation.

● Ethnic - a social group of people who identify with each other based on shared

characteristics that distinguish them from other groups such as a common set of

race, traditions, language, history, culture, nation, and religion.

● Financial Influence - refers to the economic status of the student and the cost of

the treatment that may affect the student’s preference for a treatment.

● First-degree burns - burns that affect only the outer layer of the skin.

● Headache - a pain in any region of the head.

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● Herbal medicines - remedies and medicines participants use made from plants;

methods may vary from culture to culture.

● Massage therapy - the scientific manipulation of the muscles and soft tissues of

the body utilizing manual techniques such as stroking, kneading, and rubbing.

● Meditation - a practice where an individual uses mindfulness or focus to train

attention and awareness to achieve a mentally clear and emotionally calm state.

● Muscle cramps - a sudden and involuntary contraction of one or more of your

muscles.

● Non-pharmacological pain management - interventions to treat pain omitting use

of medications.

● Religious/Spiritual Influence - faith or belief in divine or supernatural intervention

for healing

● Sociocultural factors - the larger scale forces within cultures and societies that

influence the thoughts, feelings, and behaviors of the people.

● Social Influence - refers to the familial and peer guidance in seeking pain relief.

● Stomach ache - a pain in the patient’s stomach.

● Tawal-tawal - a religious practice that uses charm or incantation (often in Arabic

or Malay), and is recited to bring about a desired change in physical or mental

condition as to heal a sickness or to relieve pain.

● Traditional healing practices - health practices which fall outside of

pharmaceutical or surgical treatments, and may involve plant, animal or mineral-

based medicines, energetic therapies, or physical/hands on techniques.

● Hot compress - a method of applying heat to the body to relieve pain or stiffness.

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 ● Yoga - a form of exercise combining physical and mental exercises aimed to

create union between body, mind, and spirit.

Conceptual Framework

This study focuses on the cause-and-effect relationship between two key

variables: sociocultural factors as independent or predictor variables and the choice of

non-pharmacological treatment for acute pain as the dependent or response variable.

The researchers generally expect that sociocultural factors on a person have a direct

effect on their choice of treatment. Inclusive of the factors that the researchers seek to

study are religious beliefs and practices, customs and traditions, social influences, and

their economic or financial status.

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 These specified determinants are aspects of a person’s sociocultural identity,

hence one aspect influences another. One or more sociocultural factors may surpass all

others as the primary cause of the person’s preference of health interventions. Similarly,

certain sociocultural factors may have perceptions of lesser effects on the choice of pain

therapy.

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 Chapter 2

REVIEW OF RELATED LITERATURE

In this section of the paper, the researchers present and discuss related

literature and studies in four section strands: (1) the implication and effects of

Pharmacological management in a wide variety of pain; (2) rebuttals and limitations of

Pharmacological treatments; (3) comparison between non-pharmacological and

pharmacological management of pain in different cultures; and (4) implication and some

ethical limitations of non-pharmacological and pharmacological management of pain.

FOREIGN STUDIES:

The perception of pain differs from one another, as it is based on several

sociocultural factors and lifestyle. There is pain that are less expressed due to the

anxiety from medical interventions, limitations from cultural background, stress impact

that can be contributed to the family, and the denial to invest in medical drugs and

costly medical services. Moreover, the initial response of acute pain can be assisted

medically or managed non-pharmacologically based on patients’ social, cultural,

spiritual or religious and financial influences.

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 In line with the several factors that differ an individual’s pain perception and

response to seek medical assistance, non-pharmacological methods of managing acute

pain are applicable for patients with firm sociocultural principles. A descriptive study by

Birge, O.U. (2018) is performed to determine the pain beliefs of patients and the

nonpharmacological methods they use to manage their pain. Birge mentions that:

The types of pain most frequently experienced by the patients were headaches

(24.8%), joint pain (21.6%), and lumbar pain (19.6%). It was determined that 72.3% of

the patients used medication for pain, and that 27.7% also resorted to

nonpharmacological methods for managing the pain. Frequently preferred

nonpharmacological methods included hot and cold therapy, massage, and herbal

methods.

It is stated that muscular pain is the usual condition that can be assisted by a

non-pharmacological procedure. Given that analgesic drugs are offered to immediately

relieve the pain, there are still patients (27.7%) that initially prefer a non-medical

approach along the lines of their cultural and social practices. Hence, the initial

response can reflect on the patient's common beliefs, social expectations and attitudes.

In 2015, a thematic analysis that was conducted by Peltomäki reveals that

children under 18 years old use non-pharmacological methods in relieving pain and the

nurses’ background effects on their use of non-pharmacological methods as well. The

results show that nurses only use limited non-pharmacological methods. This means

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that the study implies that nurses need more education on the use of non-

pharmacological methods.

For Chinese nurses used more non-pharmacological methods than American

nurses. The methods were varying within all cultural groups, but usually methods from

all these four categories, physical, cognitive-behavioral, emotional and other methods,

were used. For nurses, pain management practices primarily means that they can use a

large variety of non-pharmacological methods regardless of the child’s cultural

background.

Culturally sensitive care may improve effective implementation through Cultural

sensitivity in pain can be practiced. In the end, Peltomäki suggested that nurses need to

be more aware and active in their non-pharmacological pain management and must

acknowledge how their own background might affect the use of non-pharmacological

methods. This means that the education of nurses should also cover the cultural

diversity of non-pharmacological pain management. Surprising to the researchers is the

fact that there were no more available studies of culture’s influences on non-

pharmacological pain management of children.

On the other hand, an article was made by Chen, L., Dodd, M., Miaskowski, C., &

Pantilat, S. (2008) entitled Concepts within the Chinese Culture That Influence the

Cancer Pain Experience. It describes some of the concepts within the Chinese culture

that influence the sociocultural dimension of the cancer pain experience. According to

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its researchers, the major concepts that influence Chinese patients' perspectives on

cancer pain and its management include Taoism/energy, Buddhism, and Confucianism.

Within the beliefs of Taoism/energy, pain occurs if Qi, or blood circulation, is

blocked. To relieve pain, the blockage of Qi/blood must be removed, and the person

needs to maintain harmony with the universe. Within the beliefs of Buddhism,

pain/suffering is a power, unwanted but existent, that comes from a barrier in the last

life; from the objective world; from a person's own sensation; or from other people,

animals, and materials.

Only by following the 8 right ways (i.e., right view, right intention, right speech,

right action, right livelihood, right effort, right mindfulness, and right concentration) can

an individual end the path of pain/suffering. A Confucian believes that pain is an

essential element of life, a "trial" or a "sacrifice." Therefore, when a person suffers with

pain, he or she would rather endure the pain and not report it to a clinician until the pain

becomes unbearable.

Pain medicine is one of the most arguable discussion between Islam and

utilitarian ethicists that uses to defending dynamic killing on the grounds of anticipation

of mercilessness and appeal to advantage. The specialist puts importance to torment

prescription, in view of its authenticity and adequacy. The specialist thinks on the

contemporary Islamic talk on the issue; by facilitating investigating the essential

wellsprings of Islamic law and morals.

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 The urgent portion of the article ponders with sufficient conversation on the

definition of Islamic situation on torment drugs inside the contemporary talk on the issue

that is in accordance with the legitimate proverbs and general direction from the

essential wellsprings of Islamic law and morals. Even though others contend that if a

patient isn't to be executed, the patient has the right to live effortlessly; agony and

enduring are genuine damage.

In Greco-Arabic Medicine, where it provides compositions that are particularly

aims to improved treatment with data identified regarding menstruation and pelvic

pain/uterine torment/dysmenorrhoea and its administration with diet treatment, hijamah

bila shart (dry measuring), takmeed (hot fomentation), nutool treatment, and therapeutic

spices with antispasmodic, also the study provided pain relieving properties in herbals

that are highly used Muslim household, such as ginger, rose, fenugreek, cumin, etc.

These spices lately are pharmacologically demonstrated for their mitigating,

antispasmodic, and pain-relieving exercises (Sultana, 2015). Networks also stressed

the culture of the idea regarding well-being and sickness as social ideas and the

coordination of remedial measures with patient's convictions. Profound faith is mostly

used alleviating torment in Islam incredibly influences the way of life and the way how

Muslim adapts to torment. Regularly petitions with laying hands on the temple or spot of

agony were extracted from Narratives and Quran refrains.

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 For Islam petition fortifies the patient's relationship with God and faith in God's

capacity and insight. During supplication, the patient feels God's assurance, quiet and

secure. Petition furnishes passionate similarity with the agony by changing over the

feelings got from dread and hopelessness to suspicion that all is well and good, trust,

trust, positive thinking (Asadzandi, 2019).

Non-pharmacological Management for Migraine or tension-type Headache

Migraine was defined by Mayo Clinic (2019) severe throbbing pain or a pulsing

sensation, usually on one side of the head. It is often accompanied by nausea, vomiting,

and extreme sensitivity to light and sound. People living with migraine and/or tension-

type headache utilize Non-pharmacological or psychological self-management

interventions, excluding biofeedback and physical therapy.

The evidence found that some preliminarily measures used by the groups,

including CBT, educational and mindfulness components, appears to be associated with

larger effects than those who did not (Bowers et al., 2017). In correlation to this, a study

suggested the common therapies that are seldomly used in the health care setting such

as hot and cold compress, relaxation techniques, aromatherapy, deep breathing and

music may be utilized to treat migraines (IBM Corporation, 2020).

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 WebMD (2020) stated that migraine can be avoided when people refrain from

doing the following: tying the ponytail too tight, using Bright or flickering light from the

computer screen, chewing gum can hurt not just your jaw but your head and being

dehydrated. They also provide some remedies to counteract migraine like drinking tea,

coffee, or something with a little caffeine in it, and taking time to massage the forehead,

neck, and temples can help ease a tension headache.

In addition, a study conducted by Harvard Medical School in the year 2016, Heidi

Godman suggested that Adding magnesium to the diet, as a supplement, B vitamins

and Vitamin E and Acupressure on pressure point LI-4 (Hegu) may also play a role in

managing headache symptoms. In summary acute migraine is an important treatable

cause of neurological disability that cannot be ‘cured’ in any sense but can be managed.

Non-pharmacological Management for Dysmenorrhea

Aside from the Greco-Arabic way of treating Dysmenorrhea, Sharghi (2019) also

suggested the use of complementary medicine, drug therapies, and acupressure to

treat dysmenorrhea. The complementary medicine looked into the use of plants such as

fennel, chamomile, and Zataria multiflora.

Fennel belongs to the Umbelliferae family and the main ingredients found in it

are anethole, limonene, and fenchone. Its roots, leaves, and fruits have anti-

inflammatory and antispasmodic properties. The fruit of the fennel plant is a source of

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anethole. Anethole is very similar to dopamine. It binds to the dopamine receptor and

inhibits pain and suppresses contractions induced by oxytocin, prostaglandin E2,

acetylcholine, and histamines.

While Chamomile flowers contain some 120 chemical compounds including

flavonoids, glycoside 3%, azolin, apigenin, and methoxycoumarin. Flavonoids are the

main agents responsible for antispasmodic and antioxidant effects. Chamomile is a

plant with analgesic, antipyretic, antirheumatic, anti-inflammatory, carminative and

sedative properties known for increasing menstrual blood flow.

On the other hand, Zataria multiflora contains thymol, which inhibits

contractions caused by cell scaling and blocks the calcium channel, thus directly

affecting pain receptors and eventually inhibiting the release of prostaglandins

(Sharghi, 2019).

Hence, their study concluded that Medicinal plants, drugs, and acupressure

seem to suppress pain by reducing the level of prostaglandins, mediating nitric oxide,

increasing beta-endorphin levels, blocking the calcium channel, and enhancing

circulatory flow through the uterine pathway.

Non-pharmacological Management for Bruises

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 Homeopathic Arnica is so widely believed to be an effective treatment for bruises

and other minor traumas that it is found in the medicine cabinets of millions of people.

Arnica is a plant of the daisy family that bears yellow daisies like flowers. Native to

cooler regions of the northern hemisphere, it is sometimes cultivated as an ornamental.

a preparation of arnica used medicinally, especially for the treatment of bruises.

The study done by the team of EBSCO CAM Review Boards revealed that

Participants with bruises on one arm were treated with Arnica or placebo before the

experiment. It reveals that those who receive Arnica have benefited from the plants

(EBSCO CAM Review Board, 2015).

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 Non-pharmacological Management Painful Stimuli

In 2007, a study was conducted by Davim and Torres regarding Non-

Pharmacological Strategies (NFS) on pain relief. Their study also covers the effects and

implications of Non-Pharmacological management on the respondent of the study.

They have picked 30 pregnant participants who were chosen to participate in the

study. For researchers they describe pain as a complex, individual, and multifactor

phenomenon, In a way, pain can be shared from the reports by those who feel it,

characterized by normal transformations.

They narrowed their non-pharmacological method into respiratory exercises,

muscle relaxation, lumbosacral massage, walking, pelvic balancing and shower

bathing. The following reveals that:

● The walking (6.6%) and pelvic balancing (3.3%) strategies were not selected to

verify the effectiveness

● (80.0%) Respiratory exercises, muscle relaxation, lumbosacral massage and

shower bathing obtained acceptance percentages above 80.0%.

■ With a significant result of p=< 0.05 verified effectiveness

participants who were undergoing an active stage of labor.

■ It was identified that, when three associated NFS, respiratory

exercises, muscle relaxation and lumbosacral massage were

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 applied together, creates a significant difference in the relief of pain

intensity among participants with 6, 8 and 9 cm of dilation of the

cervix

In the end, Davim and Torres conclude that among the six NFS (Non-

pharmacological Management) for pain relief in the labor process only the respiratory

exercises, muscle relaxation, lumbosacral massage, and shower bathing were being

chosen as an accepted thing to do that has a significant positive effect on pain, while

walking and pelvic balancing were rejected.

Acupuncture

There are several theories attempting to explain the mechanism of how

acupuncture contributes to relieve the sensation of painful stimuli. The main justification

cited in clinical studies is the view that during the use of acupuncture, there is an

increase in the concentration of several neurotransmitters, such as endomorphin-1,

enkephalins, beta-endorphins, serotonin and dopamine, both in the brain and in the

blood serum. These substances act as an analgesic that calms and improve the

regeneration of motor functions.

Thermotherapy

Another study directed by Michalczyk, M., Torbé, D. and Torbé, A. in 2018 which

greatly contributed to the variety of non-pharmacological management for labor pain.

They creatively include Labor in the water immersion that involves immersion of the

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woman in warm water to a level at which the abdomen is under its surface and a pool or

tub. They reveal that Immersion of the body in warm water improves blood flow in the

utero-placental unit that eventually reduces the perception of painful stimuli.

Aromatherapy

Aromatherapy was also included, and it is identified as another drug-free method

of treating pain of childbirth that is based on the use of plant essential oils. Although the

mechanism of the analgesic effect of this method is not clear. But hypothetically the

researchers explain that essential oils increase the release of endogenous

neurotransmitters of a calming and relaxing effect. They can be rubbed into the skin,

inhaled directly or through the heater.

The essence of the approach of these methods to the problem of labor pain is

interference on the body mind system, basing on conscious control of muscle tone,

developing the ability to release tension and maintaining a sense of relaxation. This is

accompanied by full breath control, meditation and support with visualization

techniques.

Non-pharmacological Management for Lower Back Pain

DO, Funiciello (2019) Stated that the range of lower back pain can benefit from

either heat and cold therapy. He explained that lowering the body temperature by

applying cold packs within 24 hours can be beneficial for patients who are more likely to

24
experience lower back pain because it can constrict the vessel, reduce swelling and

decrease inflammation and cause numbing effects.

He also added in one of his discussions that once inflammation has subsided,

the utilization of heat therapy can improve the flexibility of soft tissue, movement of

muscles, and overall functioning of the back. Hot compress also stimulates blood

circulation in the lower back, that brings healing and nutrients to the injured tissue.

Non-pharmacological pain management for Stomach/Abdominal pain

Mann (2012) wrote an article that is reviewed by Louise Chang, MD. The article

was a review on a study that was conducted in 2012 by the National Sleep Foundation.

In his article he states that a normal adolescent who sleeps more than 8 hours has

more pain tolerance than those who do less than 8 hours of sleep. He also presents that

getting enough sleep may decrease the inflammation caused by the release of

prostaglandin.

Knibbs (2021) also added that sleeping in a fetal position, followed by twisting of

the legs from side to side, can help alleviate mild discomfort caused by the release of

hydrogen, methane and carbon dioxide gas in the digestive system that needs to be

expelled from the body. Sleeping for more than 8 hours helps to provide a reset when it

comes to food-related bloating. This allows the intra-bowel contents to be whittled down

a bit and for bloating to subside.

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 Jha & King (2006) revealed the rationale and scientific explanation for the “old

wives tale” of applying a hot water bottle on the area of deep pain within the body

including stomach and abdomen. She stated that “hot compress can physically shut

down the normal pain response involved in stomach aches, period pain or colic.”.

Although she said that heat provides comfort, she also indicates that heat application

also has its placebo effects.

Like painkiller she says it also deactivates the pain at a molecular level within the

body. Jha & King (2006) also found that a temperature of more than 40 degree (104F)

applied to the skin, it switches off the heat receptors at the site of injury. Therefore, it

blocks the body’s ability to detect pain Bubnis (2018) also states that massaging the

abdomen can greatly alleviate the pain experienced within the abdomen for it relaxes

the stomach muscle and stimulates the GI tract which in return facilitates bowel

movement and thus relieves constipation.

Non-pharmacological Management for Burns

Adult burn patients experience pain during wound care despite pharmacological

interventions. A systematic review was undertaken in order to examine the implications

of previous research for evidence-based decisions concerning the use of non-

pharmacological nursing interventions.

26
 In their study the non-pharmacological intervention had a positive effect on pain

outcomes with no adverse effects and among all the best available evidence-based

intervention a distraction relaxation technique was much preferable according to the

researcher.

For Alencar de Castor, Leal and Sakata (2013), their studies focus on alleviation

of pain in burn patients. In their study they define non-pharmacological therapy as an

important measure complementary to medication to manage pain and anxiety in burn

patients. It should be initiated as early as possible in order to prevent the development

of anxiety, which can perpetuate the cycle of pain. The approach should be

multidisciplinary, involving psychologists, psychotherapists, physiotherapists, and pain

specialists.

Psychology techniques such as relaxation, distraction, and cognitive-behavioural

therapy, are beneficial for relieving anxiety and pain during rehabilitation. In supporting

the psychological aspects of pain, some study shows that a great efficacy in alleviating

pain through distraction interventions, particularly those using virtual reality shows the

largest effects on pain relief (Koranyi, S., Meissner, W., Scheffler, M. Strauß, B. &

Rosendahl, J., 2018).

Mindfulness Meditation

27
 An experimental research by Zeidan, F., et al. (2010) proved that “mindfulness

meditation is an effective nonpharmacological method that attenuates the subjective

experience of pain”. A twenty-minute meditation consecutively performed in three days

by a patient experiencing mild muscle pain, while other participants were provided by a

distractive intervention such as by solving math problems.

The researcher noted patients’ rate of pain before and after each intervention.

The results significantly show an improvement of pain coping mechanisms and thereby

a gradual decrease of pain. Meditation as a non-medical approach is said to have an

analgesic effect which also considers reducing psychological problems, and to improve

time sensitivity and the ability to concentrate on current situations. On the other hand,

accomplishing math problems as a distraction from pain has no significant improvement

compared to a mindfulness meditation.

Massage Therapy and Relaxation

A research article entitled “Non-Pharmacological Pain Management” further

described non-pharmacological pain management as an inexpensive method which can

be applied as an adjuvant during the acute level of pain sensation, with high safety

standards and low undesired side-effects (Geziry, A.E., et al 2018).

In terms of massage as a nonpharmacological method, it is well-known that this

can increase blood and lymphatic circulation which reduces pain and improves

functional capacity. It is an intervention that can simply be done anywhere by anyone

28
who is capable of manipulating body tissues and muscles. However, the manipulation of

massage and its mechanism in reducing the pain is still unidentified.

Yet, there are several studies that have revealed that the process of massage

stimulates the release of dopamine from the brain, in which it helps to decrease the

level of pain. Massage therapy also results in the relaxation of the muscle tension that

often ascends during the occurrences of pain (Geziry, A.E., et al, 2018).

People used to perform massage as an initial type of non-medical approach for

the reason that this has an evidence-based practice obtained from the elderly ones and

health care providers. It is socially influenced which effectively contributes an analgesic

effect to the stimulated portion and can release muscle spasms and inflammation.

Furthermore, Adams, R., Beckett, C. & White, B., conducted research on the

topic of “The Effects of Massage Therapy on Pain Management in the Acute Care

Setting” which has fifty-three targeted respondents from medical, surgical, and

obstetrics units. Each participant has received 30-minute massage therapy and is

individually evaluated based on their pain scale scores before and after the said

intervention.

Even though an individual is under the healthcare services of medical

professionals, non-pharmacological techniques are also given depending on the

patient’s approval and personal or cultural preferences. The study also demonstrated

29
that there are various ways to improve the healing process that encompasses a

patient’s physical and emotional status affecting several factors such as sleeping,

relaxation, and self-capacity or independence during a hospital stay.

Sociocultural Factors Affecting Choices of Treatment among Adolescents

Mindfulness, religious and spiritual activities not only show increased pain

tolerance but also show greater life satisfaction and psychological well-being. This

preferential relationship with coping is chosen rather than relieved of pain, that showed

strong positive relationships between spiritual well-being and other measures of

psychological well-being is much of a priority in those living with pain (McCabe, MPhty,

Austin; & Siddall, 2018).

A review of related literature done by Dedeli and Kaptan (2013) on the biology

and neurobiology of pain has given this paper a relationship between spirituality and

pain. The literature showed that there was a growing recognition that persistent pain is a

complex and multidimensional experience stemming from the interrelations among

biological, psychological, social, and spiritual factors. They also stated that patients with

pain use a number of cognitive and behavioral strategies to cope with their pain,

including religious/spiritual factors, such as prayers, and seeking spiritual support to

manage their pain.

In some other findings they revealed the Interpersonal relationships also affect

the coping of pain in a large group of young adolescents. Simons, Claar & Logan found

30
in their study in 2008 that adolescent’s coping techniques and parental responses and

adolescent ache behaviors have a correlation. Passive, active, and accommodative

coping fashions confirmed that adolescent coping and parental minimization each

uniquely contributed to accelerated somatic symptoms.

Therefore, with these results, Simons, Claar & Logan suggested that teaching

parents to go away from being overly protective or solicitous as well as discounting or

criticizing the adolescent's pain as immoderate to a center ground of validating the

individual's pain trip and encouraging functioning even in the presence of ache can also

lead to better effects for these adolescents.

They also additionally encourage that equipping parents with equipment to help

their adolescents whilst concurrently educating adolescents’ skill of coping with their

ache will sooner or later end result in higher effects for the adolescent and parent.

Another presenting study published by Hatchetter et al. in 2006 strengthened the study

done by Simons, Claar & Logan found in their study in 2008 stated that maternal

impacts in adolescence' independence in torment the executives' decisions by utilizing a

subjective strategy.

In spite of the fact that youths detailed self-curing for repetitive agony, pain-

relieving use was generally mother-helped through Intergenerational transmission of

data about pain management. Shared perspectives and pain management underscored

31
the job of mothers as models for and fundamental facilitators of their young children's

progress towards self-medication for pain.

The discoveries from this investigation offer further help for maternal effects on

youngsters' pain articulation, just as proof for maternal impacts on teenagers' torment

the board decisions. A conceptual model done by Palermo, T. M., Valrie, C. R., &;

Karison, C. W. in 2014 revealed that pain and pain-related incapacity peak all through

adolescence.

This amplification in persistent ache may additionally be associated with pubertal

improvement and the associated physical, cognitive, emotional, and social modifications

that accompany improvement for the duration of adolescence. A primary developmental

consequence of youth is achieving autonomy or separateness from mother and father

emotionally, in decision making, and in ideas.

The stability between parental involvement and autonomy seems to be a

complicated and integral trouble for youngsters with persistent pain. However, given the

truth of the role of guardian and family influences on adolescent’s ache and disability,

guardian intervention techniques have been incorporated into many cognitive-

behavioral treatments (CBT) for children with pain conditions. In general, parent

strategies have targeted on operant strategies (e.g., minimizing response to ache

32
complaints, encouraging adaptive behavior) taught to parents in brief person or crew

sessions.

A preliminary study performed by Beecham, Eccleston and Sleed (2005) also

includes the Economic factors and Financial effects of Pain. The study explored the

economic factors and costs of chronic pain in adolescence. Related data for this

population and estimated the cost-of-illness of adolescent chronic pain. It shows that

adolescents with chronic pain were linked with unit costs and economic impact of

adolescent chronic pain was found to be high.

The mean cost per adolescent experiencing chronic pain was approximately

£8000 per year, including direct and indirect costs. The adolescents attending a

specialized pain management unit, who had predominantly non-inflammatory pain,

accrued significantly higher costs, than those attending rheumatology outpatient clinics,

who had mostly inflammatory diagnoses. Extrapolating the mean total cost to estimated

UK prevalence data of adolescent chronic pain demonstrates a cost-of-illness to UK

society of approximately £3840 million in one year.

Social factors also affect an individual’s pain tolerance and threshold. It is

revealed in a review of persistent pain done by Imani, & Safari in 2011. They stated that

patients will not always provide a rationalization for how some humans not only ‘‘cope’’

(a medicalized concept) on the other hand additionally live successfully with persistent

pain. The new area of positive psychology argues for transferring focal points away from

33
the study of dysfunction, in an effort to find out what unique practices, beliefs, and

attitudes appear to promote exceptional characteristic and personal happiness.

Tracy (2017) also furnished new insight into the role of dyadic social relationships

to modulate the communication of pain, particularly in relation to reputation and sex

differences in dyad pairings. The presence of another individual throughout the

experimental ache tasks resulted in an amplify in each pain threshold (i.e., resulting in a

greater point at which the participant first perceived the stimulus to be painful) and pain

tolerance (i.e., the point at which the participant ought to no longer tolerate the noxious

stimulus) for each the cold pressor check and strain algometry, compared with when the

participant accomplished the duties alone.

34
LOCAL STUDIES:

Filipino Culture and Pain Management

Cultural backgrounds vary from each individual, and there are numerous non-

pharmacological methods relating to the beliefs and practices of the Filipino non-

indigenous and indigenous group that is still being applied up until these days. In line

with that, Galanti, (1997) stated that, “Most Filipinos can be stoic, so they do not rely on

the expression of pain to determine a person's level of pain. Some patients have a high

pain threshold, yet they understand the numeric scale of expressing pain.

Filipinos are fearful of becoming addicted to narcotics”. Some of the health care

providers offer pain medications immediately, yet the situation depends on the choice of

the patient. Once again, a health professional that considers the patients’ decisions and

sociocultural preferences chiefly values the ethical principle of autonomy.

In other words, one of the Filipino cultures is by way of enduring pain during its

acute phase. Non-pharmacological techniques are mostly being implemented at this

stage, aside from advancing on some over-the-counter analgesic drugs. They only seek

medical assistance when acute pain already turns to chronic pain, which somehow puts

the patient’s condition at risk, depending on the case.

35
 It is in fact evidence-based that Filipino citizens have fears with the possibility of

drug intolerance when they keep on committing to a drug or pharmacological therapy.

Additionally, aside from choosing non-pharmacological methods due to financial

concerns, Filipinos also tend to avoid taking pharmacological drugs for the reason of the

apprehensiveness from the negative side effects of certain medications. Furthermore,

there are three common traditional healing practices identified in Zamboanga City

including:

● sahuma (magntatawas)

● subada (hilot)

● herbalism

Sahuma or mangtatawas can be considered as an unconventional way of health

assessment. Here, the practitioner places tawas (alum), kemenyan (incense), candle

from burial and blessed palm in a container to burn with charcoal in front of the patient.

(Esperat et al., 2020). The practitioner then performs certain gestures while praying

Based on the finding of an image formed by the smoke and candle wax, the healer can

identify the origin of the sickness.

In subada or hilot,the patient’s radial pulse will be read to determine any areas of

“skeletal misalignment (baldao) or energy imbalances (pasmo).” Then, the traditional

healer massages the affected body part with coconut oil or ointment and wraps it with

tangan-tangan leaves to be left overnight withholding cold drinks and taking showers.

Part of the treatment is to take an aromatic bath in a decoction of sampalok leaves after

36
recovery. Herbalism or botanical medicine is “the practice of making or prescribing plant

based herbal remedies for medical conditions'', (Shiel, 2017).

Practitioners of this field may or may not be licensed medical doctors. In the

study conducted by Esperat and Garcia in 2020, it reveals that plants assume a

significant function in Subanens. In their belief systems, plants and people have their

own soul that should be taken acceptable consideration of and esteem their quality in

the climate. In this examination, Subanens from the investigation barangays of

Sindangan utilizes an assortment of plants to treat various types of infirmities.

Furthermore Esperat et al. (2020) further discusses in their study that the

administration of medicinal plants include drinking a decoction, bathing in a decoction,

topical application, and chewing. To name a few, santol or guyabano leaves are used to

treat body pain or swelling by wrapping it onto the affected area. Malunggay and sinaw-

sinaw leaves treat wounds by applying their crushed leaves on the affected part.

Lagundi leaves can be boiled for a decoction to treat cough and fever.

The Filipino culture includes the behavior of being devoted to one’s occupation

and is particularly committed towards one's own passion. With that, health maintenance

is essential in order for them to keep moving forward. Due to the practice of overtime

working, health issues can usually be encountered. In the rural areas in the Philippines,

accordingly, some ethnic groups prefer “hilot” for the relief of pain and aches instead of

seeking medical assistance.

37
 Gandeza, N. & Ordonez, R. (n.d), defined that, “Hilot may refer to a practitioner

or the practice of chiropractic manipulation and massage for the diagnosis and

treatment of muscular-ligamentous and musculoskeletal ailments”. More so, Filipino

workers commonly use readily home remedies as the initial response for acute pain,

and the application of liniments and topical ointments that are made from organic

constituents is preferable for curing different types of muscle pain.

In line with that, Filipinos tend to choose an alternative procedure to combat

fatigue and frequent muscle pain from overstressing at work. They respond by using a

readily available technique, such as hilot, to regain regular health functioning. Before

seeking medical attention, Filipinos also value the opinions of a trusted friend or the

elder family members in regard to their condition (Gandeza, N. & Ordonez, R., n.d.).

Hilot, on the other hand, is one of the non-pharmacological interventions that can

effectively relieve acute pain, stress and anxiety.

Moreover, Filipino workers only seek medical assistance when their condition is

already at its advanced stage. This further provides an alarm to the medical

practitioners on pursuing a thorough assessment with an increased sensitivity between

Filipino patients. The healthcare team can also promote health through an early

detection of diseases and health risks in the community.

38
 Chapter 3

METHODOLOGY

In this chapter, the researchers will describe the approach and techniques used

to conduct the research and the rationale for the choice of the methods. These will be

explained in five sections: (1) research design; (2) sampling design; (3) research

instruments; (4) research locale; (5) participants; and (6) data gathering procedure.

Research Design

This study utilized a quantitative approach, and in particular, a causative-

comparative research design. Based on the chosen treatment methods of the students,

the researchers analyzed the relationship between the non-pharmacological pain

managements and its influence by sociocultural factors of their ethnic group.

Furthermore, there was a comparison of data among the ethnic groups.

Sampling Design

For this study, stratified random sampling was performed for gathering of

respondents and data. The sample size from the total population of AdZU Grade 12

STEM SHS students was stratified into three ethnic groups: Zamboangueño, Tausug,

and Bisaya, and then random sampling was done per ethnic group.

39
Research Instruments

The research tool for data gathering was a multiple-choice survey containing a

series of questions on the preferred method of management alternative to medications

to certain types of pain, and which sociocultural factor most likely affects that choice.

This multiple-choice survey was created through Google Forms. Social media platforms

such as Facebook messenger and email were utilized as a bridge of communication

between the researchers and class moderators. Electronic gadgets such as mobile

phones and laptops were tapped to access these social media platforms.

Research Locale

With the ongoing quarantine, this study was home-based. The collection of data

was through dissemination of an online survey to the Ateneo de Zamboanga University

senior high school students, and they answered from their homes.

Ethical Consideration

This study observed the principle of voluntary participation. The respondents who

participated did so based on their own free will and decision. Respect was given to

students who refused to take part in this study. Moreover, withdrawal of responses was

permitted. This study highly observed confidentiality and anonymity of the respondents.

40
Participants

The target respondents for this study were the grade 12 STEM students enrolled

in Ateneo de Zamboanga University. This is due to their age range of 16-20 years old.

Typically, adolescents around this range have developed the independence or

autonomy of making simple health care habits and practices.

The total population amounted to 614 students. Slovin's formula was used to

calculate the sample size of students to be included in the research. With a chosen

confidence level of 95%, the sample size totaled 242 students to participate in the

study.

Data Gathering Procedure

Prior to conducting the study, the researchers provided a letter of consent to the

dean of the College of Nursing and to the senior high school class moderators

requesting approval of data gathering from the Grade 12 STEM students. With the

assistance from the researchers’ moderator, the online survey link was disseminated to

particular STEM class moderators for them to forward it to their respective class

sections.

Furthermore, the researchers were able to ‘direct message’ via FB messenger

the online survey link to students of other STEM sections. A letter addressed to the

respondents for their consent had been attached with the online survey link. Through

41
this, the researchers were able to present the focus and purpose of the study and the

rights of the students before they opt to participate.

It was emphasized that the survey was only applicable to Zamboangueño,

Tausugs, and Bisaya ethnicities, and only for the STEM students. Queries and

clarifications regarding the study were encouraged and answered.

The data gathered from the survey were monitored and automatically recorded

by Google Forms. By using this platform, a database record of all the responses was

automatically provided using a spreadsheet. However, since the researchers had to

compare data across ethnic groups, the researchers had to manually tally responses

per stratum of the study. The frequency of the tallies was then presented in bar and

column graphs.

Data Analysis

The responses of the survey were processed through utilizing causal-

comparative research design. The data analysis tools that were applied to the data set

were frequencies and percentages. Frequency refers to the number of times the data

variable occurs. A frequency chart of a compilation of responses among each ethnic

group per survey item was created using a spreadsheet in Microsoft/ Google Excel.

42
 For data concerning the preference of an initial response to pain, a multiple-

choice item was given, either ‘drug options’ or ‘non-drug options.’ This is a close-ended

question that expected the respondents to select the choice that significantly applies to

them.

For the data on the preference on the non-pharmacological management

depending on the type of pain given, the survey questionnaire presented a select-all-

that-apply item per pain presenting the possible treatments that the respondent would

prefer. This method is a semi-open-ended question. If ever a respondent’s personal

choice did not appear in the checkbox list, he/she had the option to select ‘Others:’ and

freely type in his/her answer.

For the data regarding the primary sociocultural factor affecting their choices,

another multiple-choice item was given. Choices include ‘religious/spiritual influence’,

‘social influence’, ‘cultural traditions/lifestyle’, and ‘financial influence’. This is another

close-ended question that expected the respondents to select the choice that

significantly applies to them.

43
 Chapter 4

RESULTS AND DISCUSSION

The preference of AdZU Grade 12 STEM students per ethnic group on drug

versus non-drug options as an initial response to pain:

Figure 1

Figure 1 presents the frequency of preference for drug versus non-drug pain

management among the students. Based on the data gathered, the majority of the
44
Zamboangueño and Tausug respondents prefer to take pain medications as an initial

response. Among the Zamboangueños, 61% opted for drug options, while 39% opted

non-drug options. Among Tausugs, 68% chose drug options, while 32% chose non-drug

options.

On the other hand, 56% of Bisaya respondents selected preference for non-drug

options, and 44% selected preference for drug-options. Hence, the Bisaya stratum of

this study’s sample is the ethnic group that most prefers non-pharmacological pain

management as an initial response compared to the Zamboangueño and Tausug strata.

Regardless of the comparison between ethnic groups, 39.7% of the students

initially use non-pharmacological measures to treat acute pain and 60.3% use

medicine/analgesics. This may imply that these adolescents have easy access to

medicine to provide immediate relief. This prompt choice indicates that self-medication

is a common practice among the respondents. According to a study by Alawaad & et al

(2017), self-medication is prevalent among adolescents, with analgesics as the most

common medication. Sources of these drug options mainly come from accessible

pharmacies, and then parents. These may be due to ‘free consultations’ on over-the-

counter medications by the pharmacists, ‘cultural ties’, and ‘strong relationships

between parents and adolescents’ which may impact the choice to self-medicate

pain.Similarly, in a Norweigan study by Holager, T, et al (2009) on Attitudes to over-the-

counter analgesics among 15-16 year-old teenagers, there were findings that

45
“analgesics were used to treat pain to the same extent by all students, irrelevant of sex

and cultural background.”

The preference of drug versus non-drug type of treatment that is based on

ethnicity is still unclear. A larger number of Bisaya respondents may be needed to

further evaluate their preference since the difference in the response for drug versus

non-drug is minimal. Further ethnographic studies of each stratum need to be

conducted to provide additional explanation.

Commonly preferred non-pharmacological pain management (NPM) for acute

pain:

46
 Figure 2.1

In general, the respondents’ three highest non-pharmacologic preferences are

Rest/Sleep (95.5%), Massage/Hilot (55.4%), and Breathing Exercises (35.5%). Figure

2.1 shows that the ranking of these preferences remains consistent even when the

ethnic groups are independent from each other. Furthermore, other responses include

water therapy (hydration). Sleep deprivation and too much sleep (hypersomnia) can

cause headache and migraine (Jennum & Jensen, 2002). Insomnia and poor sleep

quality have been associated with a higher frequency and intensity of headache attacks.

The severity and prevalence of sleep problems is found to have a correlation with

headache. The association of headaches and sleep problems is bidirectional: sleep

disturbances can precipitate headache/migraine, and headache/migraine also causes

sleep disturbances. The National Sleep Foundation’s sleep time duration

47
recommendation is 7 to 9 hours or more for young adults to promote optimum health

and prevent headache/migraine attacks (Hirshkowitz et al, 2015). Resting the eyes in a

quiet, darkened room can alleviate symptoms of headache/migraine (MedlinePlus: US

National Library of Medicine, 2019).

According to Dr. Ben Benjamin (2017), Ph.D., founder of the Muscular Therapy

Institute in Cambridge, Massachusetts, (as cited in Zargozdon, 2018) suggests that

clients experiencing headache can do self-massage exercises on their eyes, nose,

mouth, and haw. These exercises can also prevent headache attacks. According to

Susan Juczak, a massage therapist in North Carolina, (as cited in Zargozdon, 2018)

acupressure is a technique where specific pressure points in the hands can be used to

minimize headache/migraine. Hegu, also called Pressure point LI-4, is found between

the base of the thumb and index finger. Pressing this area using the thumb and index

finger for 5 minutes can relieve pain and headaches. The pressure must be firm and the

thumb should move in circles while pressure is applied (Memorial Sloan Kettering

Cancer Center, 2019).

Headaches are also caused by stress and tension. Breathing techniques can

help relax the tensed muscles in the body. Slow Deep Breathing Exercises have an

effect that decreases headache pain. (Aritonang, 2020). This is done by long inhalation

and slow exhalation. Visualized Breathing is a relaxation technique using imagination.

Closing the eyes and letting your mind visualize the calmness entering the body while

48
inhaling and picture tension leaving the body when exhaling. Rhythmic Breathing can

also relieve muscle tension by breathing long, slow breaths and counting one to five

when inhaling and exhaling (Lava, 2019).

Figure 2.2

For headaches experienced by a total of 124 Zamboangueño respondents, social

influence affects 66.9%, followed by cultural influences affecting 21%, then financial

influence affecting 8.9%, and religious influence affecting 3.2%. For headaches

experienced by a total of 77 Tausug respondents, social influence affects 53.2%,

followed by cultural influences affecting 26%, then religious influence affecting 13%, and

financial influence affecting 7.8%. For headaches experienced by the 41 Bisaya

respondents, social influence affects 56.1%, followed by cultural influences affecting

49
39%, then financial influence affecting 4.9%. Up to this date, there are still no related

local literature that can support this finding on headaches/migraines in a sociocultural

perspective.

Figure 3.1

Bisaya respondents rank Herbal (65.9%), Rest/Sleep (36.6%), and Prayer (22%)

as their top three choices of non-pharmacological pain relief for first-degree burns.

Tausug respondents also prefer Herbal (58.4%), Rest/Sleep (35.1%), and Prayer

(19.5%). Zamboangueño respondents opt Herbal (63.7%), Rest/Sleep (44.4%), and

Distraction (22.6%) for first-degree burns pain management. Moreover, other

50
preferences of the respondents include application of toothpaste, petroleum jelly, cold

compress, and by immersing the affected area in cool water. Herbal plants such as aloe

vera, also branded as ‘burn plant’, is capable of healing first- to second-degree burns.

(Maenthaisong et al., 2007). Aloe vera is anti-inflammatory, antiseptic and has

analgesic contents. (Scully, 2014). It’s gel is naturally soothing and can relieve soreness

and pain.

Pain and swelling in first-degree burns are mild. Studies show that one of the

most predictors of pain intensity is the number of sleeping hours a person had the night

before (Irving, 2013, p.13). Hence, poor quality of sleep may worsen the pain the next

day.

The most common non-pharmacological spiritual intervention for pain is prayer.

(El Geziry et al., 2018). Individuals experiencing pain may practice various spiritual and

religious activities to effectively cope with their pain, reduce pain intensity, and lessen

the degree to which pain disrupts the activities of daily living (Bernstein et al., 2017).

51
 Figure 3.2

For first-degree burns experienced by the 124 Zamboangueño respondents,

social influence affects 54%, followed by cultural influences affecting 29.8%, then

financial influence affecting 12.1%, and religious influence affecting 4%. For first-degree

burns experienced by 77 Tausug respondents, social influence affects 58.4%, followed

by cultural influences affecting 29.9%, then religious influence affecting 6.5%, and

financial influence affecting 5.2%. For first-degree burns experienced by the 41 Bisaya

respondents, social influence affects 53.7%, followed by cultural influence affecting

36.6%, then financial influence affecting 9.8%. Religious influence has not been an

apparent primary factor for this type of pain. Up to this date, there are still no related

local literature that can support this finding on first-degree burns in a sociocultural

perspective.

52
 Figure 4.1

Out of the 242 participants in the study, the majority of the population chose Cold

Compress as their preferred method of non-pharmacological pain management for

bruises. As shown in Figure 4.1, there are a total of 195 answers for Cold Compress,

divided between 36 Bisaya (14.88%), 57 Tausug (23.55%), and 102 Zamboangueño

(42.15%) respondents. This result can be supported by King (2017) as he states that

bruises caused by contusion can be treated in a non-pharmacological way by applying

local cold compression to encourage vasoconstriction which decreases inflammation

and swelling within the area of injury.

53
 The results also show that the second most preferred method is Rest/Sleep, with

a total of 17 Bisaya (7.02%), 25 Tausug (10.33%), and 62 Zamboangueño (25.62%)

respondents. The outcome can be supported by Cheever et al. (2010) in their textbook

“Brunner & Suddarth’s Textbook of Medical-Surgical Nursing,” as he stated that rest by

avoiding the use of an injured area can lessen strains and contusion of the soft tissue of

the skin. Furthermore, immobilization can also prevent further injury and give the body

time to recover.

Lastly, it is shown that Herbal Medicine is the top third chosen non-

pharmacological management for bruises, with a total of 17 Bisaya and 17 Tausug

(7.02%) and 30 Zamboangueño (12.40%) respondents. King (2017) stated that topical

application of arnica can lead to a reduction in the development of a bruise and may

increase the speed of resolution. In addition to some respondents, they also mentioned

other methods such as distraction, aromatherapy, and meditation as their strategy in

managing their bruises.

54
 Figure 4.2

For bruises experienced by the 124 Zamboangueño respondents, social

influence affects 58.9%, followed by cultural influences affecting 33.1%, then financial

influence affecting 6.5%, and religious influence affecting 1.6%. For bruises

experienced by the 77 Tausug respondents, social influence affects 61%, followed by

cultural influences affecting 32.5%, then religious influence affecting 3.9%, and financial

influence affecting 2.6%. For bruises experienced by the 41 Bisaya respondents, social

influence affects 65.9%, followed by cultural influence affecting 31.7%, then financial

influence affecting 2.4%. Religious influence has not been an apparent primary factor

for this type of pain. Up to this date, there are still no related local literature that can

support this finding on bruises in a sociocultural perspective.

55
 Figure 5.1

In the 4th question, the participants were asked regarding the preference of

managing muscle cramps non-pharmacologically. Figure 5.1 shows that massage or

hilot is the primary choice of treatment for muscle cramps from the ethnic group of

Bisaya (80%); consuming 33 answers over 41 respondents, Tausug (74%); with 57

answers over 77 respondents, and in Zamboangueños (72%); with 90 answers over

124 Zamboangueño respondents. In addition, approximately 65% in Bisaya, 45% in

Tausug and 60% from the Zamboangueño ethnic group answered Rest and Sleep as

their treatment of choice in muscle cramps, and it is the second highest choice by the

three ethnic groups. The top 3rd choice of the three groups is the application of Cold

Compress or ice packs on the affected muscle, with 46% in Bisaya, 36% in Tausug and

41% from the Zamboangueños. Moreover, some respondents mentioned other methods

such as stretching, increasing water intake, and exercising as their strategy in managing

56
muscle cramps. In relation with the study by Gandeza, N. & Ordonez, R. (n.d), he

mentioned that “Several ethnic groups prefer hilot for the relief of pain and aches

instead of seeking medical assistance. Filipino workers commonly use readily home

remedies as the initial response for acute pain and this includes methods such as hilot,

and the use of herbal medicines.” Based on the data gathered, it is evident from the

three ethnic groups that massage and hilot is the most commonly practiced form of

treatment that is intended for managing muscle aches. It is widely convenient, and it can

be performed by anyone who is capable of massaging the muscles for function

enhancement.

Figure 5.2

For muscle cramps experienced by the 124 Zamboangueño respondents, social

influence affects 67.7%, followed by cultural influences affecting 25%, then financial

57
influence affecting 5.6%, and religious influence affecting 2.4%. For muscle cramps

experienced by 77 Tausug respondents, social influence affects 61%, followed by

cultural influences affecting 33.8%, then religious influence affecting 3.9%, and financial

influence affecting 1.3%. For muscle cramps experienced by the 41 Bisaya

respondents, social influence affects 68.3%, followed by cultural influence affecting

29.3%, then religious influence affecting 2.4%. Financial influence has not been an

apparent primary factor for this type of pain. Up to this date, there are still no related

local literature that can support this finding on muscle cramps in a sociocultural

perspective.

Figure 6.1

58
 Out of the 242 participants that participated in the study, the majority of the

population chose Massage/Hilot as their methods to relieve back pain. As shown in

Figure 6.1, there are 35 Bisaya (14.46%), 60 Tausug (24.79%), and 106

Zamboangueños (43.80%), totaling 201 participants (83% of the population), who prefer

Massage and Hilot. For management of back pain, the results prove that massage as a

non-pharmacological method is beneficial due to its tremendous effects in the body,

such as increased blood and lymphatic circulation, and relaxation of muscle tension,

that often leads to soothe occurring pain (Geziry, A.E., et al, 2018).

The second topmost chosen non-pharmacological management for back pain is

Rest/Sleep. Among the 242 participants in the study, 27 Bisaya (11.16%), 39 Tausug

(16.12%), and 89 Zamboangueños (36.78%) chose Rest/Sleep as one of the better

ways to relieve back pain, totaling 155 participants (64.05% of the population).

Researchers have long seen that discomfort from back pain can be a major barrier to

sleep. To be included in an article written by Eric Suni reviewed by Dr. Jenny Iyo, they

confirmed that Sleep allows healing of the muscle, changes mood and affect in a

positive way, by balancing the chemicals in the brain that are involved in how we

experience pain (Suni, 2020).

Also included in the topmost chosen non-pharmacological management for back

pain is hot compress. In a total of 242 participants, 77 respondents (31.82%) say that

Hot Compress relieves their back pain and among those 77 respondents, the result is

59
divided between 18 Bisaya (7.44%), 21 Tausug (8.68%), and 38 Zamboangueños

(15.70%). Together with Hot compress is the application of Cold compress that shows

49 (20.25%) of the respondents selected in treating back pain. This significantly

indicates that the respondents find hot compress as a convenient management for back

pain. This is supported by DO, Funiciello, M. (2019), as stated in one of his articles

published on Spine-Health that the range of lower back pain can benefit from either heat

or cold therapy. He explained that lowering the body temperature by applying cold

packs within 24 hours can be beneficial as it constricts the vessel, reduces swelling, and

decreases inflammation and causes numbing effects. He also added that once

inflammation has subsided, the utilization of heat therapy can improve the flexibility of

soft tissue, movement of muscles, and overall functioning of the back. Hot compress

also stimulates blood circulation in the lower back, that brings healing and nutrients to

the injured tissue. Furthermore, some respondents mentioned other methods such as

stretching, increasing water intake, yoga, aromatherapy, meditation, and exercising as

their strategy in treating back pain.

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 Figure 6.2

In connection with the sociocultural factors in choosing different modalities for

back pain, the following revealed the weight percentage of different factors that affects

the majority of the respondent’s decision in choosing which type of non-pharmacological

modalities can be utilized for back pain. It discloses that 124 Zamboangueño

respondents, social influence affects 67.7%, followed by cultural influences affecting

25%, then financial influence affecting 5.6%, and religious influence affecting 2.4%. For

back pain experienced by 77 Tausug respondents, social influence affects 59.7%,

followed by cultural influences affecting 33.8%, then religious influence affecting 5.2%,

and financial influence affecting 1.3%. For back pain experienced by the 41 Bisaya

respondents, social influence affects 61%, followed by cultural influence affecting 39%.

Both religious and financial factors do not influence these respondents. Up to this date,

61
there are still no related local literature that can support this finding on backpain in a

sociocultural perspective.

Figure 7.1

With a grand total of 242 respondents, Figure 7.1 shows that a greater number of

respondents chose that rest and sleep helps alleviate stomachache, while Hot

compress and Massage follows. As shown in figure 7.1, 27 Bisaya (11.16%), 50 Tausug

(20.66%), and 87 Zamboangueños (35.95%) with a total of 164 respondents (67.77%).

The result was further supported by Mann (2012) in his article that is reviewed by

Louise Chang, MD. In his article, he states that a normal adolescent who sleeps more

than 8 hours has more pain tolerance than those who do less than 8 hours of sleep. He

also presents that getting enough sleep may decrease the inflammation caused by the

release of prostaglandin. In line with the discussion, Knibbs (2021) states that sleeping

62
in a fetal position, followed by twisting of the legs from side to side, can help alleviate

mild discomfort caused by the released of hydrogen, methane and carbon dioxide gas

in the digestive system that needs to be expelled from the body. Sleeping for more than

8 hours helps to provide a reset when it comes to food-related bloating. This allows the

intra-bowel contents to be whittled down a bit and for bloating to subside.

For the second topmost chosen Non-pharmacological modalities for stomach

pain Hot compress was chosen by 164 respondents. Jha & King (2006) revealed the

rationale and scientific explanation for the “old wives’ tale” of applying a hot water bottle

on the area of deep pain within the body including stomach and abdomen. She stated

that “hot compress can physically shut down the normal pain response involved in

stomach aches, period pain or colic.” Although she said that heat provides comfort, she

also indicates that heat application also has its placebo effects. Like painkiller she says

it also deactivates the pain at a molecular level within the body. Jha & King (2006) also

found that a temperature of more than 40 degree (104F) applied to the skin, it switches

off the heat receptors at the site of injury. Therefore, it blocks the body’s ability to detect

pain. And lastly in cases like constipation and bowel retention Abdominal massage is

said to be an effective way to alleviate GI distention and nausea caused by bowel

retention (Bubnis, 2018). Additionally, some respondents mentioned other methods

such as stretching, increasing water intake, herbal medicine, medication, and distraction

as their strategy in providing relief for stomach\abdominal pain.

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 Figure 7.2

In relation with the Sociocultural factors in choosing different modalities for

stomach/abdominal pain the following revealed the weight percentage of different

factors that affects the majority of the respondent’s decision in choosing which type of

non-pharmacological modalities can be utilized for stomach/abdominal pain. For the 124

Zamboangueño respondents, social influence affects 60.5%, followed by cultural

influences affecting 32.3%, then financial influence affecting 4.8%, and religious

influence affecting 2.4%. For stomachache or abdominal pain experienced by 77

Tausug respondents, social influence affects 58.4%, followed by cultural influences

affecting 36.4%, then religious influence affecting 3.9%, and financial influence affecting

64
1.3%. For stomachache or abdominal pain experienced by the 41 Bisaya respondents,

social influence affects 68.3%, followed by cultural influence affecting 29.3%, then

religious influence affecting 2.4%. Financial factors do not influence choice treatment for

this type of pain. Up to this date, there are still no related local literature that can support

this finding on stomachache or abdominal pain in a sociocultural perspective.

Figure 8.1

The female respondents (F=134) from the three ethnic groups were questioned

on their preferences of non-drug treatment in handling menstrual cramps or

dysmenorrhea. The data gathered shows that Rest and Sleep is the primary choice of

treatment from the female respondents of Bisaya (92%: 22/24 Bisaya female

respondents) and Zamboangueño ethnic (87%: 52/60 Zamboangueño female

65
respondents). However, the application of Hot compress is the primary choice of the

Tausug female respondents (78%: 42/54 Tausug female respondents), and followed by

rest and sleep (65%: 35/54 Tausug female respondents). The top 3 rd treatment of

choice is massage in Bisaya (37.5%: 9/24), Tausug (24%: 13/54) and the

Zamboangueños (38%: 23/60). More so, distraction as a way of managing

dysmenorrhea also ranked 3rd in Bisaya female respondents (37.5%: 9/24). In relation to

that, a study of female patients (n= 62) conducted by Bertalanffy et al., (2006) shows

that hot compress or electric heating blanket is effective in decreasing pain and anxiety

in patients with pelvic pain and menstrual cramps. This finding suggests that heat

application can be performed in the emergency unit, rather than by administering

analgesics. With that, the female patients from different ethnicities can refer to this non-

drug treatment in the healthcare unit with respect to their sociocultural beliefs. Another

related study by Armour, M., et. al. (2019) with a total of 2,302 women respondents. It

shows that heat therapy (92.9%) has a moderate improvement in reducing pain and its

duration than the use of analgesic drugs (76.5%). It states that heat, acupressure and

exercise can be an adjunct method in managing acute menstrual pain, with high efficacy

and is more convenient for women. However, differentiating the frequency and the

severity of menstrual cramps is essential, in order to determine suitable treatments and

to prevent reproductive health complications. In addition, heat therapy may not be

effective as it is for obese and overweight women. Women in the community must also

be educated with the proper use of warm compress in maintaining heat by 38 to 40

degrees, and by applying it 4-5 times a day in 15 to 30 minutes per session.

66
 Figure 8.2

For dysmenorrhea experienced by the total of 60 female Zamboangueño

respondents, social influence affects 66.7%, followed by cultural influences affecting

28.3%, then financial influence affecting 5%. Religious influences appear to be

irrelevant in the choice of treatment since the option had zero responses. For

dysmenorrhea experienced by a total of 54 female Tausug respondents, social

influence affects 63%, followed by cultural influences affecting 37%. Religious and

financial influence were not selected by any of the female respondents. For

dysmenorrhea experienced by a total of 24 female Bisaya respondents, social influence

affects 62.5%, followed by cultural influences affecting 33.3%, then financial influence

affecting 4.2%. Religious influence was not selected by any of the female respondents.

67
Up to this date, there are still no related local literature that can support this finding on

dysmenorrhea in a sociocultural perspective.

Discussion on Effects of Sociocultural Factors on the Respondents’ Preferences

Prevalent across all the types of acute pain given for the respondents to relate,

social influence is constantly perceived as the major factor affecting their preferred non-

pharmacological pain management. Consistently, cultural traditions/lifestyle follows as

the second major factor. The least of the perceived influences are financial and

religious/spiritual influence and their order being either the least or second least varies.

In a developmental perspective study by Karlson, C. W., Palermo, T. M., and

Valrie, C. R. (2014), social influence is evident as a significant factor in an adolescent’s

development when handling pain. It states that, “a major developmental outcome of

adolescence is achieving autonomy or separateness from parents emotionally, in

decision making, and in ideas.” There must be a balance between parental involvement

and autonomy in self-administration of treatment. Moreover, there is evidence for

maternal influences on adolescent’s pain management choices in a qualitative

investigation by Hatchette, J. E. et al (2006). Mothers play a significant role in parental

involvement as they impart ‘share attitudes’ and ‘pain management strategies.’ These

were through mechanisms of ‘verbal communication,’ ‘modelling,’ and ‘facilitating

autonomy.’ In the research article by Alawaad & et al (2017), peer influence was an

68
insignificant external factor behind self-medication among adolescents. The researchers

proposed the idea that it “could be explained by the fact that adolescents think it is time

for them to develop their own decisions without the influence of their friends.”

Regarding cultural traditions/lifestyle, there are no related ethnographic studies

on cultural influences and pain treatment. Often, it has been used loosely and

imprecisely in other research studies, correlating its definition in terms of racial or ethnic

group. According to Finley, G. A., Kristjánsdóttir, O., & Forgeron, P. A. (2009),

institutions “have their own culture that can have a significant influence on the clinical

practice of health professionals.” This may involve the respondent’s past experiences in

pain management depending on the environment/institution they are in. A specific type

of pain management abided with the societal norms, hence is selected in future

concerns. In the related study, it states that, “Institutional culture – the environment in

which the child, the parent and health professional coexist” may influence the

modification of subsequent pain management. Therefore, the student who may

experience pain while in school may approach the school clinic and may acculturate in

selecting the norm treatment options based on the institution’s culture and not of one’s

own. Further research is required to understand the manner in which diverse societal

culture influences institutional culture and, therefore pain management.

Among Zamboangueños and Bisaya respondents, financial influence is the third

major factor. This may imply that these students consider the financial aspects of

69
receiving the treatment more so than the religious aspects. Generally, financial

influence may be among the least of the influences because students from this private

school are assumed to be economically fortunate and can afford treatment, especially of

the pharmacologic type. Non-pharmacological treatments for acute pain are expected to

be cheap and less burdensome compared to treating chronic pain. In a preliminary

study by Beecham, Eccleston and Sleed (2005), it shows that “adolescents with chronic

pain were linked with unit costs and economic impact of adolescent chronic pain was

found to be high.”

It was observed among the Tausug ethnic group of students that

religious/spiritual influence was their third major factor. This may depict that they involve

spiritual guidance in their health actions more than considering financial aspects.

Religious/spiritual influences may not frequently be part of the decision-making of

adolescents. This may be supported by a review on Religious Involvement, Spirituality,

and Medicine: Implications for Clinical Practice by medical doctors Mueller, P., Plevak,

D. & Rummans, T. in 2001. It discusses that religious and spiritual coping are more

“common among nursing home residents and the elderly population.” It further explains

that it is largely involved among patients with moderate to high levels of chronic pain in

contrast to acute pain. People may start to rely on religious beliefs as the illness or pain

prolongs and begins to interrupt routines, drain finances, separate families, and create

situations of dependency.” Acute pain among adolescents in the study may not yet have

led to existential or spiritual concerns.

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 Chapter 5

SUMMARY OF FINDINGS, CONCLUSION, & RECOMMENDATION

Summary of Findings

This quantitative research has a total number of two hundred forty-two (242)

participants of the Grade 12 STEM Senior High School students of AdZU. Survey link

questionnaires were provided through social media platforms, with the utilization of

stratified random sampling. The researchers aim to classify the ethnic group that prefer

non-drug therapy and to determine what influences the students from their preference of

managing pain non-pharmacologically.

Common non-drug methods in managing minor aches were also questioned, and

the factors that influence their choices could be based on their socio-cultural, religious,

financial, and/or cultural influences. From the total number of respondents (n= 242),

there are 41 Bisaya (M: 17/F: 24), 77 Tausug (M: 23/F: 54), and 124 Zamboangueño

(M: 64/F: 60) respondents. The data gathered shows that the Bisaya (56% for non-drug

and 44% for drug choice) prefers the use of non-drug methods in managing acute pain

the most, while the Zamboangueños (39% for non-drug & 61% for drug choice) and the

Tausug (32% for non-drug & 68% for drug choice) group prefer a drug option. As a

71
whole, 39.7% of the students chose nonpharmacological methods, while 60.3%

preferred medicine/analgesics.

The common non-pharmacological procedures of the three ethnic groups were

identified by allowing students to select specific methods in handling various types of

acute pain. In headaches and migraines, the most preferable non-drug method of the

three groups is Rest/Sleep (100% in Bisaya & Zamboangueños; 91% in Tausug),

followed by Massage or Hilot (B: 73.2%, T: 44.2%, & Z: 56.5%), and then Breathing

Exercises goes third for Bisaya (44%) and Zamboangueños (34%), while prayer is the

third choice of the Tausug group (42%).

For first-degree burns, the common non-drug methods are Herbal medicines (B:

65.9%, T: 58.4% & Z: 63.7%), Rest/Sleep (B: 36.6%, T: 35.1% & Z: 44.4%) and Prayer

(B: 22% & T: 19.5%). Distraction goes third for the Zamboangueños (22.6%). For

bruises, the top three common non-drug methods by the three ethnic groups are Cold

Compress (B: 87.8%, T: 74% & Z: 83.9%), Rest/Sleep (B: 41%, T: 32% & Z: 50%), and

Herbal medicines (B: 41%, T: 22% & Z: 24%).

For muscle cramps, the top three preferable methods are Massage or Hilot (B:

80%, T: 74% & Z: 72%), Rest and Sleep (B: 65%, T: 45% & Z: 60%), and Cold

Compress application (B: 46%, T: 36% & Z: 41%). For back pain, the top three

preferable non-drug interventions are Massage and Hilot (B: 85%, T: 78%, & Z: 85.5%),

72
Rest and Sleep (B: 66%, T: 51%, & Z: 72%), and third is the application of Hot

Compress (B: 39%, T: 27% & Z: 31%).

For abdominal pain, the common non-drug method for the Bisaya and Tausug

are Rest/Sleep (B: 68% & T: 71%), Hot Compress (B: 66% & T: 65%) and

Massage/Hilot (B: 56% & T: 30%). Herbal Medicines also goes third for the Tausug

group. Moreover, the top three common methods for the Zamboangueños are Hot

Compress (70%), Rest/Sleep (69%), and Herbal Medicines (31%).

Lastly, the most common non-drug method used by the female respondents (B:

24, T: 54 & Z: 60 female respondents) in managing menstrual cramps or dysmenorrhea

are Rest/Sleep (B: 92%, T: 65% & Z: 87%), Hot compress (B: 83%, T: 78% & Z: 70%),

and Massage/Hilot (B: 37.5%, T: 24% & Z: 38%).

In addition, Distraction is also on top three for the Bisaya female respondents

(37.5%). Furthermore, findings show that the primary factor that influenced student's

choices in managing several types of acute pain is generally the social influences,

specifically parental influences.

Conclusion

In this era of increasing pharmaceutical industry and strengthening efficacy of

substances, many adolescents are unavoidably choosing pharmacological substances

73
in managing several types of pain. However, as seen in this study, if given the

alternative, some adolescents also turn to non-pharmacological treatments for their

pain. In this study, stratified-random sampling was used to determine the relationship

between the non-pharmacological pain managements and its influence by sociocultural

factors of the 242 adolescents with different cultures and religions that were being

reviewed and examined via google survey questionnaires. The data showed that 60.3%

of these adolescents prefer pharmacological substances in dealing with acute pain.

However, the Bisaya group revealed specifically that the majority of their population

prefer the use of non-drug methods in managing acute pain, while both

Zamboangueños and the Tausug mostly prefer drug options.

Although, the study revealed that majority of the population group chooses drug

options in managing acute pain, the study further assesses each respondent’s non-

pharmacological pain management for Headache/Migraines, First-degree (mild) burns,

Bruises, Muscle cramps, Back pain, Stomach Ache/Abdominal pain and Dysmenorrhea.

The study further shows that among all sociocultural factors, social influence such as

common peers, family, and institutions, greatly influence the majority of the

respondents’ choice of a specific non-pharmacological pain treatment for each type of

body pain. Majority of the respondents say that internal pain, like headaches and

migraines, stomach/abdominal pain, and dysmenorrhea, can be best resolved with

rest/sleep and massage/hilot when utilizing a non-drug treatment. For muscular pain,

such as bruises, muscle cramps, and back pain, the majority of respondents say that

massage/hilot, cold and warm compress are helpful in managing the pain.

74
 Lastly, for first degree burns, the majority of respondents say that Herbal

medicines, Rest/Sleep and Prayer can best resolve enduring pain. Overall, even though

the majority of the respondents prefer drug options in treating pain, there are still

several non-pharmacological options they utilize for an alternative.

Taking everything into account, adolescents' decisions are largely affected by

social influence, especially by parental guidance. Hence, legitimate and proper family

health teaching on acute pain management must be emphasized and implemented for

the care of well-being of each potential client within a community setting, where an area

is known to be scant and monetary abundance is an issue. Additionally, as researchers

and future medical caretakers and nurses, being sensitive to social contrasts and

similarities should be noticed. Individual patients' needs and preferences must be

considered in the planning of care for clients experiencing acute pain to ensure top-

quality care is delivered to every client at the emergency clinic, ward or community

setting.

Recommendation

The following recommendations are proposed based on the limitations and

conclusions of this study for future studies and application:

(1) Utilizing a qualitative research design to elicit specific and personal response;

(2) Conduct ethnographic studies to explore accurately the social and cultural

aspects of pain management focusing on a specific ethnicity;

75
(3) Modification of age groups and researching other ethnic minorities in

Zamboanga, such as Subanon, Yakan, Samal, Cebuano, and Tagalog;

(4) Variation of research locale: Public schools or institutions with poor clinic

facilities and barangay health centers to establish and deliver care/treatment

base on the non-pharmacological preference of the students or the people in the

community; and

(5) Imparting health education in schools and communities is to be emphasized

regarding the possible alternatives of drugs for pain management so as to avoid

over-dependence on drugs.

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 APPENDIX A – Sample Letters

Ateneo de Zamboanga University

COLLEGE OF NURSING
La Purisima, Zamboanga City

February 15,2021

GRADE 12 CLASS MODERATOR

AdZU SENIOR HIGH SCHOOL DEPARTMENT
ZAMBOANGA CITY, REGION IX

Dear Sir/Madam:

Greetings of Peace!
 
 
In partial fulfilment of our Nursing Research requirement, we, the Level III nursing students of Ateneo de
Zamboanga University, College of Nursing, are conducting a research study entitled “Correlation between
Sociocultural Factors of AdZU Grade 12 STEM SHS Students and Preference of Non-Pharmacological Management
for Acute Pain.”
 
In line with this, the undersigned request a consent to conduct the data gathering from your students. We
humbly ask for your facilitation in distributing our survey questionnaire to students who are of
Zamboangueño, Bisaya and Tausug ethnicity. We hope for your utmost cooperation as we aim to determine the
sociocultural influences in pain management from the students.
 
Rest assured that the data we will gather will remain absolutely confidential and will be used for academic
purposes only. If you have any question or concerns, you may contact the group leader Charisma Pastor (0997 952
8860) or our Nursing Research Moderator Mrs. Jana Bello Rivera (0927 676 6909).
 
Your approval to conduct this study will be greatly appreciated. Below is the link to our online survey:
https://forms.gle/1Mgz69UCMZwqNRWm6

Respectfully yours,

Charisma E. Pastor
Clouise Junice B. Renolla
Richelle Mae F. Reyes
Jorgee H. Sahali
Nur-hathi M. Sanaani
Researchers
Noted by:

Jana Bello Rivera, RN, MN

Nursing Research Moderator

Maria Lorna B. Paber RN, MAN

Dean- College of Nursing

Letter to Respondents and Informed Consent on Google Form

77
78
 APPENDIX B – Survey Questionnaire

ID Number: __________________

STEM Section: _______________

Gender: _____________________

Age: _______________________

Ethnicity: ___________________

PART I - Your Initial Response to Pain

1. Which do you prefer to take as an initial response to pain?

a. Drug options for pain b. Non-drug options for pain

PART II - Your Choice of Non-Drug Pain Treatments

2. Which non-drug pain treatment do you prefer for headaches/migraines?

a. Acupuncture g. Aromatherapy

b. Meditation h. Herbal Medicines

c. Breathing Exercises i. Prayers

d. Distraction j. Tawal-tawal

e. Rest/Sleep k. Other: ________________

f. Massage/Hilot

79
 Which factor do you think most influences your choice?

a. Religious/Spiritual Influence c. Cultural Traditions/Lifestyle

b. Social Influence d. Financial Influence

3. Which non-drug pain treatment do you prefer for first-degree (mild) burns?

a. Acupuncture f. Aromatherapy

b. Meditation g. Herbal Medicines

c. Breathing Exercises h. Prayers

d. Distraction i. Tawal-tawal

e. Rest/Sleep j. Other: ________________

Which factor do you think most influences your choice?

a. Religious/Spiritual Influence c. Cultural Tradition/Lifestyle

b. Social Influence d. Financial Influence

4. Which non-drug pain treatment do you prefer for bruises?

a. Meditation e. Aromatherapy

b. Cold compress f. Herbal medicine

c. Distraction g. Other: ________________

d. Rest/Sleep

Which factor do you think most influences your choice?

80
 a. Religious/Spiritual Influence c. Cultural Tradition/Lifestyle

b. Social Influence d. Financial Influence

5. Which non-drug pain treatment do you prefer for muscle cramps?

a. Acupuncture h. Aromatherapy

b. Yoga i. Herbal Medicines

c. Meditation j. Prayers

d. Breathing Exercises k. Tawal-tawal

e. Distraction l. Ice Pack/ Cold Compress

f. Rest/Sleep m. Other: ________________

g. Massage/Hilot

Which factor do you think most influences your choice?

a. Religious/Spiritual c. Cultural Tradition/Lifestyle

Influence d. Financial Influence

b. Social Influence

6. Which non-drug pain treatment do you prefer for back pain?

81
 a. Acupuncture h. Aromatherapy

b. Yoga i. Herbal medicines

c. Meditation j. Prayers

d. Breathing exercises k. Tawal-tawal

e. Distraction l. Ice pack/cold compress

f. Rest/sleep m. Hot shower/ hot compress

g. Massage n. Other: ________________

Which factor do you think most infleunce/s your choice?

a. Religious/Spiritual c. Cultural Tradition/Lifestyle

Influence d. Financial Influence

b. Social Influence

7. Which non-drug pain treatment do you prefer for stomach ache/abdominal pain?

a. Meditation g. Aromatherapy

b. Hot compress h. Herbal medicine

c. Distraction i. Breathing exercise

d. Massage j. Tawal-tawal

e. Prayers k. Other: ________________

f. Rest/Sleep

82
 Which factor do you think most influence/s your choice?

a. Religious/Spiritual c. Cultural

Influence Tradition/Lifestyle

b. Social Influence d. Financial Influence

8. Which non-drug pain treatment do you prefer for dysmenorrhea?

a. Acupuncture g. Meditation

b. Yoga h. Distraction

c. Hot compress i. Breathing exercise

d. Rest/Sleep j. Herbal medicine

e. Massage k. Other: ________________

f. Aromatherapy

Which factor do you think most influences your choice?

A. Religious/Spiritual C. Cultural Tradition/Lifestyle

Influence D. Financial Influence

B. Social Influence

83
REFERENCES:

Albatti, T. H., Alawwad, S., Aldueb, R., Alhoqail, R., & Almutairi, R. (2017). The self

medication use among adolescents aged between 13–18 years old; prevalence

and behavior, Riyadh – Kingdom of Saudi Arabia, from 2014–2015 [Abstract].

International Journal of Pediatrics and Adolescent Medicine, 4(1), 19-25.

doi:10.1016/j.ijpam.2016.05.001

Alencar de Castro, R., Leal, P., & Sakata, R. (2013). Pain Management in Burn

Patients. Brazilian Journal Of Anesthesiology, 63(1), 149-158. doi:

10.1016/s0034-7094(13)70206-x

Aritonang Y. (2020). The effect of slow deep breathing exercise on headache and vital

signs in hypertension patients. Jurnal Keperawatan Padjadjaran, 8(2), 1–9.

https://doi.org/10.24198/jkp

Arshiya Sultana, S. (2015). Management of Usr-i-Tamth (Menstrual Pain) in Unani

(Greco-Islamic) Medicine. Journal of Evidence-Based Integrative Medicine.

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