Racial Differences in Prescription of Opioid Analgesics for Chronic Noncancer Pain in a National Sample of Veterans

Burgess, Diana J.; Nelson, David B.; Gravely, Amy; Bair, Matthew J.; Kerns, Robert D.; Higgins, Diana M.; Ryn, Michelle van; Farmer, Melissa M.; Partin, Melissa R.

doi:10.1016/j.jpain.2013.12.010

Cited by 86 publications

(66 citation statements)

References 52 publications

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“…The results do not vary significantly by age group. Hence, our prior findings of lower rates of opioid prescriptions among blacks than whites younger than 65 yr did not appear to contribute to racial differences in pain outcomes [19].…”

Section: Discussionmentioning

confidence: 61%

“…This survey was mailed to patients early in the second calendar month following their SHEP index visit, and data collection was closed 4 wk after the survey was mailed. We identified a sample of patients with chronic pain (9,831 black and 71,471 white patients, referred to as the "chronic pain sample") using the same criteria as we used in our previous research examining racial differences in opioid prescriptions in VA [19] (Figure 1). The sample included non-Hispanic black or white established and new primary care patients who were selected to be in the 2007 SHEP (irrespective of whether or not they responded to the SHEP) and met the following inclusion criteria: (1) any diagnoses of back, neck, or joint pain in the year prior to the SHEP index visit; (2) no cancer diagnoses in the year prior to the SHEP index visit; and (3) no outpatient opioid prescription received in the 3 mo prior to the first pain diagnosis (Pain Diagnosis index visit).…”

Section: Setting and Participantsmentioning

confidence: 99%

“…ICD-9 codes were also used to identify 30 comorbidity measures developed by Elixhauser and colleagues for use with large administrative data sets [27]. Additional diagnoses (separate from Elixhauser measures) hypothesized to be associated with pain outcomes or pain treatment: phantom limb pain, psychogenic pain, spinal cord injury, and posttraumatic stress disorder (PTSD) were included in analyses (see Burgess et al for diagnosis codes [19]). …”

Section: Demographic and Clinical Covariatesmentioning

confidence: 99%

“…Our prior research found that among Department of Veterans Affairs (VA) patients diagnosed with a chronic musculoskeletal condition who reported moderate or high levels of pain and who were under age 65, blacks were less likely to be prescribed opioids than their white counterparts [19]. The objectives of this study were to examine whether pain outcomes (pain interference, perceived pain treatment effectiveness) among those who reported being treated for chronic pain at VA vary by race and then whether receipt of opioid prescriptions moderates these relationships.…”

Section: Introductionmentioning

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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Section: Discussionmentioning

confidence: 61%

Section: Setting and Participantsmentioning

confidence: 99%

Section: Demographic and Clinical Covariatesmentioning

confidence: 99%

Section: Introductionmentioning

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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“…There may have been a delay in diagnosis of CES for African-American patients compared to Caucasians, which may contribute to the higher rate of neurologic complications. Investigators have noted that African-American patients presenting with pain are not given pain medications in comparison to other groups [22][23][24][25][26]. Patients with CES commonly present through the emergency room (ER).…”

Section: Discussionmentioning

confidence: 99%

Outcomes Following Surgical Management of Cauda Equina Syndrome: Does Race Matter?

Jain

Menga

Mesfin

2017

J. Racial and Ethnic Health Disparities

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Cauda equina syndrome (CES) is a surgical emergency requiring urgent spinal decompression. Our objective is to analyze the association between race and in-hospital outcomes (complications, mortality, length of stay, and discharge disposition) in patients with CES. This is a retrospective cohort study of CES patients identified via the Nationwide Inpatient Sample (NIS) from 2000 to 2010 in inpatient hospitalizations in the USA. The patient sample includes 46,017 patients ≥18 undergoing spine surgery for CES. Using ICD9-CM codes, patient records with a diagnosis of CES from 2003 to 2010 were selected from the NIS database and sorted by mortality, complications, length of hospital stay, and discharge status. Demographic information (age, gender, race, and insurance status) and hospital characteristics were evaluated. African-American patients were 1.38-fold (p < 0.02; 95% odds ratio [OR] 1.05-1.83) more likely than Caucasian patients to develop complications based on a multivariate logistic regression model adjusted for patient age, insurance status, surgical approach, and hospital size. There was no difference in mortality among patients of various races in both univariate and multivariate analysis. A multivariate linear regression model adjusted for insurance status, surgical approach, and hospital size revealed that, compared to Caucasian patients, length of hospitalization in African-American patients was 1.92 days longer (p < 0.01), 1.34 days longer (p < 0.01) in Hispanic patients, and 2.24 days longer (p < 0.01) in Asian-American patients. African-American patients were 0.59-fold (p < 0.01; 95% OR 0.494-0.708) less likely than Caucasian patients to have routine discharge to home. African-American patients hospitalized for surgical management of CES experience significantly more complications, longer length of hospitalizations, and higher discharge to non-home locations, compared to Caucasian patients.

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Rates of Physician Coprescribing of Opioids and Benzodiazepines After the Release of the Centers for Disease Control and Prevention Guidelines in 2016

et al. 2019

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Key Points Question Was the release of the Centers for Disease Control and Prevention’s 2016 opioid prescribing guidelines associated with changes in the rate of coprescription of opioids and benzodiazepines? Findings This cohort study of administrative data for 4 897 464 patients found small, statistically significant decreases in the rate of coprescription in the 2 years after the guideline release. These decreases were seen only in the targeted guideline population—people using opioids long term—not in those receiving short courses of opioids. Meaning Coprescribing rates of opioids and benzodiazepines may have decreased after the Centers for Disease Control and Prevention guideline release, but associations with patient outcomes are not yet known.

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Racial Differences in Prescription of Opioid Analgesics for Chronic Noncancer Pain in a National Sample of Veterans

Cited by 86 publications

References 52 publications

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

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

Outcomes Following Surgical Management of Cauda Equina Syndrome: Does Race Matter?

Rates of Physician Coprescribing of Opioids and Benzodiazepines After the Release of the Centers for Disease Control and Prevention Guidelines in 2016

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