Assessment of Pain and Analgesic Use in African American Cancer Patients: Factors Related to Adherence to Analgesics

Abstract

This study describes pain experience, analgesic use and barriers to pain control in African American cancer patients (N = 116). The overall adherence rate of analgesics was 46%. Constipation and nausea were the most commonly cited side effects of analgesics. Eighty-seven percent of patients reported concern about addiction to analgesics. Patients who believed their doctor needed to focus on curing illness rather than on controlling pain tended to comply with analgesic prescriptions (r = 0.20, p < 0.05). Patients with concerns that analgesics may cause confusion were less likely to take any type of analgesics (r = -0.16, p < 0.05). The study confirms that a patient's perceived barriers influence their decision to take analgesics, and also suggests that African American cancer patients may benefit from education that prevents misconceptions about analgesic use.

Adherence to Analgesics for Cancer Pain: A Comparative Study of African Americans and Whites Using an Electronic Monitoring Device

“…The authors found that addiction concerns were not correlated with adherence for WHO step 2 or step 3 analgesics; rather pain intensity, side-effects, and fear of distracting clinicians were associated with analgesic adherence in African Americans with cancer pain. 38 …”

“…27, 28, 32, 43, 47, 53, 55 The very limited existing studies with African Americans are cross-sectional (e.g., computed adherence for the past 24 hours) 38 and are based on self-reported measures of adherence. 2, 22, 38, 50 Studies in non-cancer settings, comparing self-reported measures of adherence with objective measures such as electronic monitoring, have found that subjective adherence measures are not sufficiently accurate and overestimate rates of adherence by 10%–30%. 3, 7, 10, 14, 19, 54 Thus, we compared analgesic adherence for cancer pain between African Americans and Whites longitudinally using Medication Event Monitoring System [MEMS TM ].…”

Practice recommendations for pain assessment by self-report with African American older adults

“…49e51 Many older African Americans have a pre-conceived notion of the ideal patient as one who refrains from bothering health care providers in order to be viewed as the "good" or "perfect" patient. 31,49,52,53 Like so, older African Americans may perceive that communicating pain is complaining of pain, when in fact it is reporting pain. Historically, older African Americans were taught to be strong, endure the pain, avoid complaining or talking about pain and not to be "worrisome" or "needy"; that is, "be seen and not heard."…”

Pain Management for Older African Americans in the Perianesthesia Setting: The “Eight I's”

“…However, some older AAs have low expectations for pain relief, 5 believing that pain cannot be relieved. [21][22][23] These beliefs may explain why AAs feel as though they have less control over pain. [24][25][26] Therefore, engaging them in the development of their pain management plan may help them recognize the importance of taking an active role in keeping their pain under control.…”

“…57 This has implications for the use of patientcontrolled analgesia (PCA) techniques and the importance of teaching older AAs the value of ''staying on top of the pain'' and then systematically evaluating their PCA use to ensure effective selfadministration. Some AAs are reluctant to accept injections and intraspinal analgesics for pain management 21,34,[58][59][60] ; thus, thorough patient and family education is essential when these methods are required. This underscores the need to incorporate nonpharmacological interventions as well.…”