Defining Racial and Ethnic Disparities in Pain Management
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Substantial pain prevalence is as high as 40% in community populations. There is consistent evidence that racial/ethnic minority individuals are overrepresented among those who experience such pain and whose pain management is inadequate.
The objectives of this paper are to (1) define parameters of and summarize evidence pertinent to racial/ethnic minority disparities in pain management, (2) identify factors contributing to observed disparities, and (3) identify strategies to minimize the disparities.
Scientific literature was selectively reviewed addressing pain epidemiology, differences in pain management of non-Hispanic whites versus racial/ethnic minority groups, and patient and physician factors contributing to such differences.
Racial/ethnic minorities consistently receive less adequate treatment for acute and chronic pain than non-Hispanic whites, even after controlling for age, gender, and pain intensity. Pain intensity underreporting appears to be a major contribution of minority individuals to pain management disparities. The major contribution by physicians to such disparities appears to reflect limited awareness of their own cultural beliefs and stereotypes regarding pain, minority individuals, and use of narcotic analgesics.
Racial/ethnic minority patients with pain need to be empowered to accurately report pain intensity levels, and physicians who treat such patients need to acknowledge their own belief systems regarding pain and develop strategies to overcome unconscious, but potentially harmful, negative stereotyping of minority patients.
KeywordsPain Management Opioid Analgesic Implicit Association Test African American Patient Minority Individual
The author thanks Rachel Meyers for her assistance in the development of bibliographic materials.
- 1.American Pain Foundation. APF Position Statement on Reformulated Oxycontin. Released: April 15, 2010. Available at: http:www.painfoundation.org/newsroom/position statements/reformulated-oxycontin-april-2010.html. Accessed September 20, 2010.
- 4.Asher A. What is pain management? 2007. Available at: http://backandneck.about.com/od/chronicpainconditions/f/painmanagement.htm. Accessed April 24, 2010.
- 11.Boone S, Schwartzberg JG. 21st Century medicine: a case for diversity, health literacy, cultural competence and health equity. CPPD Report: AMA Continuing Medical Education. 2010;31:1–3. Available at: www.ama-ssn.org/amal/pub/upload/mm/455/cppd31.pdf. Accessed October 28, 2010.
- 19.Capps L. National Pain Care Policy Act of 2009. HR 756. 111th Congress. January 28, 2009. Available at: http://frwebgate.access.gpo.gov/cgi-in/getdoc.cgi?dbname=111_cong_bills&docid=f:h756eh.txt.pdf. Accessed May 19, 2010.
- 22.Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, Donovan MI, Fishbain DA, Foley KM, Fudin J, Gilson AM, Kelter A, Mauskop A, O’Connor PG, Passik SD, Pasternak GW, Portenoy RK, Rich BA, Roberts RG, Todd KH, Miaskowski C; American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113–230.Google Scholar
- 35.Gallagher RM. Biopsychosocial pain medicine and mind-brain-body science. Phys Med Rehab Clin North Am. 2004;15:855–882.Google Scholar
- 45.Institute of Medicine; Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatments: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press; 2003.Google Scholar
- 46.International Association for the Study of Pain (IASP). Pain. 1979;6:250.Google Scholar
- 49.Joint Commission for Accreditation of Health Organizations (JCAHO). Approaches to pain management: an essential guide for clinical leaders. 2000. Available at: http://www.jcrinc.com/generic.asp?durki=3873. Accessed December 17, 2010.
- 53.Kirsch B, Berdine H, Zablotsky D, et al. Management strategy: identifying pain as the fifth vital sign. Veterans Health System Journal. 2000;5:49–59.Google Scholar
- 56.Liebschutz JM, Saitz R, Weiss RD, Averbuch T, Schwartz S, Meltzer EC, Claggett-Borne E, Cabral H, Samet JH. Clinical factors associated with prescription drug use disorder in urban primary care patients with chronic pain. J Pain. 2010;11:1–9.Google Scholar
- 63.McDowell I, Newell C. Pain measurement. In: Measuring Health. New York, NY: Oxford University Press; 1996.Google Scholar
- 65.Melzack R. Pain and neuromatrix in the brain. J Dental Ed. 2001;65:1378–1382.Google Scholar
- 68.Mills AM, Shofer FS, Boulis AK, Holena DN, Abbuhl SB. Racial disparities in ED patients with abdominal or back pain. Am J Emerg Med. 2010 April 30 [Epub ahead of print].Google Scholar
- 82.Shavers VL, Bakos A, Sheppard VB. Race, ethnicity, and pain among the U.S. adult population. J Health Care Poor Underserved. 2010;21:177–220.Google Scholar
- 87.Staton LJ, Panda M, Chen I, Genao I, Kurz J, Pasanen M, Mechaber AJ, Menon M, O’Rorke J, Wood J, Rosenberg E, Faeslis C, Carey T, Calleson D, Cykert S. When race matters: disagreement in pain perception between patients and their physicians in primary care. J Natl Med Assoc. 2007;99:532–538.PubMedGoogle Scholar
- 100.Von Roenn JH, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ. Physician attitudes and practice in cancer pain management: a survey from the Eastern Cooperative Oncology Group. Ann Intern Med. 1993;119:121–126.Google Scholar
- 106.World Health Organization. Cancer Pain Relief. 2nd ed. Geneva, Switzerland: World Health Organization; 1996.Google Scholar