Many traditional American Indians were taught to withstand pain as a skill for survival. Overt expression of pain (verbal or non-verbal) is unacceptable in many American Indian cultures today. Older American Indian may be less likely to ask for pain medication and more likely to use internal resources to manage pain (Hendrix, 2001).
American Indians are also generally undertreated for chronic and acute pain. A request for assistance may not be repeated, or may be told to a family member who will relay the request. (Kramer, 1996)