Defining Racial and Ethnic Disparities in Pain Management

Overview

Journal Clin Orthop Relat Res

Publisher Wolters Kluwer

Specialty Orthopedics

Date 2011 Jan 21

PMID 21249483

Citations 129

Authors

Jana M Mossey

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Questions/purposes: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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References

Jimenez N, Seidel K, Martin L, Rivara F, Lynn A . Perioperative analgesic treatment in Latino and non-Latino pediatric patients. J Health Care Poor Underserved. 2010; 21(1):229-36. PMC: 4011632. DOI: 10.1353/hpu.0.0236. View

Chen I, Kurz J, Pasanen M, Faselis C, Panda M, Staton L . Racial differences in opioid use for chronic nonmalignant pain. J Gen Intern Med. 2005; 20(7):593-8. PMC: 1490156. DOI: 10.1111/j.1525-1497.2005.0106.x. View

Sheffield D, Biles P, Orom H, Maixner W, Sheps D . Race and sex differences in cutaneous pain perception. Psychosom Med. 2000; 62(4):517-23. DOI: 10.1097/00006842-200007000-00010. View

Tan G, Jensen M, Thornby J, Anderson K . Ethnicity, control appraisal, coping, and adjustment to chronic pain among black and white Americans. Pain Med. 2005; 6(1):18-28. DOI: 10.1111/j.1526-4637.2005.05008.x. View

McNeill J, Sherwood G, Starck P . The hidden error of mismanaged pain: a systems approach. J Pain Symptom Manage. 2004; 28(1):47-58. DOI: 10.1016/j.jpainsymman.2003.11.005. View

Gallagher R . Biopsychosocial pain medicine and mind-brain-body science. Phys Med Rehabil Clin N Am. 2004; 15(4):855-82, vii. DOI: 10.1016/j.pmr.2004.04.002. View

van Ryn M, Burke J . The effect of patient race and socio-economic status on physicians' perceptions of patients. Soc Sci Med. 2000; 50(6):813-28. DOI: 10.1016/s0277-9536(99)00338-x. View

Nguyen M, Ugarte C, Fuller I, Haas G, Portenoy R . Access to care for chronic pain: racial and ethnic differences. J Pain. 2005; 6(5):301-14. DOI: 10.1016/j.jpain.2004.12.008. View

Im E, Chee W, Guevara E, Liu Y, Lim H, Tsai H . Gender and ethnic differences in cancer pain experience: a multiethnic survey in the United States. Nurs Res. 2007; 56(5):296-306. PMC: 2728600. DOI: 10.1097/01.NNR.0000289502.45284.b5. View

10.

Weisse C, Sorum P, Sanders K, Syat B . Do gender and race affect decisions about pain management?. J Gen Intern Med. 2001; 16(4):211-7. PMC: 1495199. DOI: 10.1046/j.1525-1497.2001.016004211.x. View

11.

Bijur P, Berard A, Nestor J, Calderon Y, Davitt M, Gallagher E . No racial or ethnic disparity in treatment of long-bone fractures. Am J Emerg Med. 2008; 26(3):270-4. DOI: 10.1016/j.ajem.2007.05.010. View

12.

Cleeland C, GONIN R, Baez L, Loehrer P, Pandya K . Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Ann Intern Med. 1998; 127(9):813-6. DOI: 10.7326/0003-4819-127-9-199711010-00006. View

13.

Eisenberg J . Sociologic influences on decision-making by clinicians. Ann Intern Med. 1979; 90(6):957-64. DOI: 10.7326/0003-4819-90-6-957. View

14.

Lippe P, Brock C, David J, Crossno R, Gitlow S . The First National Pain Medicine Summit--final summary report. Pain Med. 2011; 11(10):1447-68. DOI: 10.1111/j.1526-4637.2010.00961.x. View

15.

Ware Jr J, Kosinski M, Keller S . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3):220-33. DOI: 10.1097/00005650-199603000-00003. View

16.

Smith R, Dwamena F, Fortin 6th A . Teaching personal awareness. J Gen Intern Med. 2005; 20(2):201-7. PMC: 1490050. DOI: 10.1111/j.1525-1497.2005.40212.x. View

17.

Staton L, Panda M, Chen I, Genao I, Kurz J, Pasanen M . When race matters: disagreement in pain perception between patients and their physicians in primary care. J Natl Med Assoc. 2007; 99(5):532-8. PMC: 2576060. View

18.

McCracken L, Matthews A, Tang T, Cuba S . A comparison of blacks and whites seeking treatment for chronic pain. Clin J Pain. 2001; 17(3):249-55. DOI: 10.1097/00002508-200109000-00011. View

19.

Ng B, Dimsdale J, Shragg G, Deutsch R . Ethnic differences in analgesic consumption for postoperative pain. Psychosom Med. 1996; 58(2):125-9. DOI: 10.1097/00006842-199603000-00005. View

20.

Edwards R, Doleys D, Fillingim R, Lowery D . Ethnic differences in pain tolerance: clinical implications in a chronic pain population. Psychosom Med. 2001; 63(2):316-23. DOI: 10.1097/00006842-200103000-00018. View