Kaumātua (Elders) Insights into Indigenous Māori Approaches to Understanding and Managing Pain: A Qualitative Māori-centred Study

Abstract

Purpose: Chronic pain/mamae is a major public health problem worldwide, and disproportionately affects Indigenous populations impacted by colonisation. In Aotearoa New Zealand, Indigenous Māori experience a greater burden of chronic pain than non-Māori. However, pain services based on Western models are unlikely to adequately meet the needs of Indigenous peoples. Little is published about traditional Māori views of, or approaches to, managing mamae/pain, knowledge that is traditionally held by Kaumātua/Elders. Therefore, this study aimed to understand Kaumātua (Māori Elder) views on the effects of pain, traditional pain management practices and mātauranga Māori (Māori knowledge) relating to managing pain.

Methods: Fourteen Kaumātua participated in individual interviews or a hui/focus group. Methods honoured tikanga (Māori protocol) and centralised whanaungatanga (relationships). Interviews and the hui/focus group were transcribed, and reflexive thematic analysis was conducted.

Main findings: Three themes were developed: 1. The multidimensional aspects of pain. Pain stretched beyond the physical and encompassed emotional and mental trauma, wairua/spiritual pain, grief from the loss of loved ones, contamination of the environment or breaches of tikanga/protocol. Some mamae/pain was described as everlasting, passing between people or generations. 2. Whakawhanaungatanga/relationships: Healing through connection. Healing of pain was seen to occur through strengthening connections with people, the spiritual realm, the natural world and with papakāinga (one’s ancestral homeland). 3. Tino Rangatiratanga/self-determination: Strength to self-manage pain. Self-reliance to manage pain and self-determination to make health decisions were critical, and a stoical approach to pain was described. Stoicism was noted to avoid perceptions of weakness and burdening whānau/family, but may inhibit emotional expression, connection and healing.

Principal conclusions: Mātauranga Māori/Māori knowledge emphasises that pain and its healing should be considered multidimensional, incorporating physical, mental and relational components, existing in the spiritual realm and incorporating links between people, places, the past and future. Individuals may approach pain with a stoical approach, which has both positive and negative features. Pain services may wish to incorporate this knowledge of the spiritual, social and psychological aspects of pain and pain management to provide more meaningful care for people with pain.