Associations Between Race and Ethnicity and Treatment for Chronic Pain in the VA

Dobscha, Steven K.; Soleck, Geoffrey; Dickinson, Kathryn; Burgess, Diana J.; Lasarev, Michael; Lee, Eun Sul; McFarland, Bentson H.

doi:10.1016/j.jpain.2009.04.018

Cited by 38 publications

(30 citation statements)

References 32 publications

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“…African Americans are less likely than whites to receive opioid analgesics for chronic pain conditions and/or other treatments, such as referral to surgery [28,93]. For example, in their study of chronic pain patients from 12 primary care practices, Chen et al [20] observed whites were 2.67 (95% CI, 1.71-4.15) times more likely than African Americans to be using opioids for chronic pain.…”

Section: Chronic Nonmalignant Painmentioning

confidence: 99%

Defining Racial and Ethnic Disparities in Pain Management

Mossey

2011

Clinical Orthopaedics &Amp; Related Research

273

215

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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.

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Section: Chronic Nonmalignant Painmentioning

confidence: 99%

Defining Racial and Ethnic Disparities in Pain Management

Mossey

2011

Clinical Orthopaedics &Amp; Related Research

273

215

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“…Racial disparities in the perception, evaluation, and treatment of pain have been extensively documented [1,6,9,11,[14][15][16]20,26,27,29,30,32,40]. Much of the work on this topic has focused on disparities in the prescribing of analgesic medications, with several studies finding that black patients are less likely than white patients to be prescribed opioids [6,19,28,35,36].…”

Section: Introductionmentioning

confidence: 99%

Racial disparities in the monitoring of patients on chronic opioid therapy

Hausmann

Gao

Lee

et al. 2013

Pain

113

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Despite well-documented racial disparities in prescribing opioid medications for pain, little is known about whether there are disparities in the monitoring and follow-up treatment of patients who are prescribed opioid medications. We conducted a retrospective cohort study to examine whether there are racial differences in the use of recommended opioid monitoring and follow-up treatment practices. Our sample included 1646 white and 253 black patients who filled opioid prescriptions for noncancer pain for ≥ 90 consecutive days at the Veterans Affairs Pittsburgh Healthcare System pharmacy in fiscal years 2007 and 2008. Several opioid monitoring and follow-up treatment practices were extracted from electronic health records for a 12-month follow-up period. Findings indicated that 26.3% of patients had opioid agreements on file, pain was documented in 71.7% of primary care follow-up visits, urine drug tests were administered to 49.3% of patients, and 21.2% and 4.2% of patients were referred to pain and substance abuse specialists, respectively. Racial differences were observed in several of these practices. In adjusted comparisons, pain was documented less frequently for black patients than for white patients. Among those who had at least 1 urine drug test, black patients were subjected to more tests, especially if they were on higher doses of opioids. Compared with white patients, black patients were less likely to be referred to a pain specialist and more likely to be referred for substance abuse assessment. Addressing disparities in opioid monitoring and follow-up treatment practices may be a previously neglected route to reducing racial disparities in pain management.

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“…At first glance, these results seem inconsistent with the large body of literature documenting racial disparities in pain care and treatment [2,4]. However, most of the literature describing racial disparities in treatment (including several studies conducted at the VA prior to the present study [20,[34][35][36][37]) examines specific types of treatment (e.g., opioid therapy, pain-relieving surgical procedures) rather than patients' evaluations of their overall quality of pain treatment. An exception is Dobscha et al who, using data from the 2005 SHEP, found that black men perceived their pain treatment to be less effective than white men, after controlling for demographics, pain, and mental health comorbidities [20].…”

Section: Blacks Whites Blacksmentioning

confidence: 57%

“…This item is drawn from the Bodily Pain subscale of the 36-Item Short Form Health Survey (SF-36) [20]. Consistent with prior research [21][22], we dichotomized responses into two categories: (1) not at all/a little bit and (2) moderately/quite a bit/ extremely.…”

Section: Study Outcomesmentioning

confidence: 99%

“…However, most of the literature describing racial disparities in treatment (including several studies conducted at the VA prior to the present study [20,[34][35][36][37]) examines specific types of treatment (e.g., opioid therapy, pain-relieving surgical procedures) rather than patients' evaluations of their overall quality of pain treatment. An exception is Dobscha et al who, using data from the 2005 SHEP, found that black men perceived their pain treatment to be less effective than white men, after controlling for demographics, pain, and mental health comorbidities [20]. It is unclear whether discrepancy between the present findings and those of Dobscha et al are due to methodological differences between the two studies or the fact that our study used data collected at a later time point, in which pain care quality in VA could have conceivably improved.…”

Section: Blacks Whites Blacksmentioning

confidence: 99%

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

et al. 2016

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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.

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Associations Between Race and Ethnicity and Treatment for Chronic Pain in the VA

Cited by 38 publications

References 32 publications

Defining Racial and Ethnic Disparities in Pain Management

Defining Racial and Ethnic Disparities in Pain Management

Racial disparities in the monitoring of patients on chronic opioid therapy

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

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