In an emergency department (ED) study and in a transcultural menopause study we investigated the influence of ethnicity and socio-demographic factors on the perception and expression of pain respectively menopausal symptoms.

Data for the ED-study were collected in three large ED's in Berlin based on standardized face-to-face interviews with ED-patients containing a verbal rating scale and a diagram of the human body to indicate the degree of pain and to localize the pain regions. The participants of the menopause study (aged 45–60 years) were recruited via random and snowball sampling in Berlin and Istanbul and surveyed with a structured questionnaire including the Menopause Rating Scale II (MRS II). Statistical analyses were performed with univariate Fisher's exact test, factor analysis, and multivariate logistic regression.

In both studies German participants had a relatively higher social and educational status. 473 patients were included in the ED-study. Compared to German and other ethnic groups the logistic regression analysis showed significantly higer scores in perceived severity of pain and in the number of reported pain locations for migrants from Turkey. A total of 963 women (Berlin: 418 German, 264 migrants from Turkey; Istanbul: 281 women) participated in the menopause study. Turkish migrants in Berlin and women in Istanbul rated their their complaints significantly higher than German women. In both studies gradual multivariate logistic regression revealed that ethnicity as well as other social determinants influence the pain expression.

Ethnic differences in pain perception and expression are reality but ethnicity may not be regardes as single factor. It is necessary to re-appraise the concept of pain both in science and in healthcare practice, particularly on the basis of a critical assessment of what constitutes the ‘norm’.