Association between pain outcomes and race and opioid treatment: Retrospective cohort study of Veterans

Abstract

Abstract-We examined whether pain outcomes (pain interference, perceived pain treatment effectiveness) vary by race and then whether opioid use moderates these associations. These analyses are part of a retrospective cohort study among 3,505 black and 46,203 non-Hispanic, white Department of Veterans Affairs (VA) patients with diagnoses of chronic musculoskeletal pain who responded to the 2007 VA Survey of Healthcare Experiences of Patients (SHEP). We used electronic medical record data to identify prescriptions for pharmacologic pain treatments in the year after diagnosis (Pain Diagnosis index visit) and before the SHEP index visit (the visit that made one eligible to complete the SHEP); pain outcomes came from the SHEP. We found no significant associations between race and pain interference or perceived effectiveness of pain treatment. VA patients with opioid prescriptions between the Pain Diagnosis index visit and the SHEP index visit reported greater pain interference on the SHEP than those without opioid prescriptions during that period. Opioid prescriptions were not associated with perceived treatment effectiveness for most patients. Findings raise questions about benefits of opioids for musculoskeletal pain and point to the need for alternative treatments for addressing chronic noncancer pain.

Racial and Ethnic Differences in the Experience and Treatment of Noncancer Pain

“…Beyond pharmaceutical treatments, several studies have examined racial and ethnic differences in multidisciplinary pain treatment program outcomes. In a large retrospective study performed at the Department of Veterans Affairs, Burgess and colleagues found no significant association between race and pain outcomes for a multidisciplinary pain treatment program [181]. However, in Merry and colleagues study examining race differences in pain-related treatment outcomes, both black and white participants experienced a reduction in pain-related interference, but only white participants reported reduced pain severity [182].…”

Psychotropic and Opioid-Based Medication Use among Economically Disadvantaged African-American Older Adults

“…Yazdanshenas, Bazargan, and colleagues (2016) revealed that there is severe mismanagement of pain among African-American older adults, which may be attributed to potentially inappropriate medications, such as opioids [ 47 ]. Further, Burgess and colleagues (2016) found opioid users reported greater pain interference compared to non-opioid users [ 48 ]. Even though African-Americans are undertreated with opioid-based medications, they are at higher odds for opioid abuse and dependence as opposed to Whites [ 49 ].…”