It is, therefore, not only the cultural differences between groups per se that influence health, but also differences between them arising from the different contexts in which they exist. Culture did account for differences in the extent to which pain was experienced as a 'dull ache', or as 'very severe, almost unbearable'. There were also significant differences in the extent to which patients wondered about what they had done to have the pain, in their feeling that they might 'lose control', about the benefit of complaining and the importance of trying to hide pain. Likelihood of becoming emotional when describing the pain and desire to have other people around when experiencing pain, also differed. Finally, whether the pain affected appetite, the ability to work and the likelihood of having been to many medical doctors, were also influenced by cultural group membership.
Different factors appear to be associated with pain in each cultural group.
Italian patients' response to pain was best predicted by the length of time they had the pain. The level of reported psychological distress was most important for explaining the pain of Jewish patients because a high level of distress was strongly associated with an emotionally expressive pain response and with interference in daily functioning. Finally, for Puerto Rican patients, high psychological distress, strong 'friendship solidarity', and dependency on other Puerto Ricans when sick and suffering chronic pain were all associated with an emotionally expressive pain response and significant disruption in daily activities attributable to pain. Overall this research suggests that while cultural groups may report similar responses to pain, different factors influence their responses. Different cultures present different settings and conditions for the expression of pain.