Sociodemographic Differences in Pain Medication Usage and Healthcare Provider Utilization Among Adults With Chronic Low Back Pain

Abstract

Chronic low back pain (cLBP) is the most common reason for individual suffering and health care utilization in adults. Ample evidence suggests sociodemographic variables and socioeconomic status (SES) influence pain. However, a framework informing associations on race, SES, and the utilization of pharmacologic therapies and provider type are limited—particularly in cLBP. Thus, this study examined the extent to which sociodemographic (i.e., age, race, and gender) and socioeconomic factors (i.e., national area deprivation index, NADI) influence pain treatment (i.e., NSAIDs, opioids, antidepressants, and non-NSAIDs) and provider utilization for cLBP (i.e., no provider care, primary care, or tertiary care). Eligible participants with cLBP completed a series of questionnaires. Of the 174 participants, 58% were women, 59% were non-Hispanic Black (NHB), and the mean age was 46.10 (SD 13.58). Based on NADI distributions by race, NHB participants lived in more socioeconomically disadvantaged neighborhoods (p < 0.001) than non-Hispanic White (NHW) adults. Results suggested that the use of one or more pharmacologic therapies was associated with race (p = 0.021). Specifically, NHW adults were two times more likely to take one or more pharmacologic therapies than NHBs (p = 0.009). NHWs were also more likely to use NSAIDs (p = 0.041) and antidepressants (p < 0.001) than NHBs. Furthermore, provider utilization was significantly associated with gender (p = 0.037) and age (p = 0.018); which suggests older women were more likely to use primary or tertiary care. Findings from this study expand on the existing literature as it relates to associations between disparities in access to healthcare providers and access to medications. Future research should seek to understand differences in age and utilization of primary or tertiary care providers and continue to examine the influence of sociodemographic and SES factors to cLBP and compare with other types of chronic pain.

The Opioid Epidemic: a Crisis Disproportionately Impacting Black Americans and Urban Communities

“…In a study of Indianapolis, Phalen et al showed fentanyl-involved OODs rose from 15% in 2010 to 50% in 2017, concomitant with a shift from a younger White to a middle-aged Black demographic [9]. The lag between White and Black OOD peaks can be attributed to biased prescribing that promote unequal access to prescription opioids based on race or ethnicity, where young White women (and men) were more likely to receive opioids for pain management than Black counterparts of any age [14][15][16]. This trend of indiscriminate prescribing to Whites for emergency and surgical interventions, cancer treatment and/or pain management was referred to as the natural/semi-synthetic wave and involved mostly codeine, morphine, hydrocodone, and oxycodone abuse [17][18][19]).…”

Characteristics of patients with myofascial pain syndrome of the low back

“…However, we found that black participants had worse physical function, higher level of disability, and higher level of best pain in the past 24 hours compared with other races. Again, no studies were found for an MPS population, but in patients with low back pain, similar findings were reported in which Black participants also reported higher level of pain severity 51,55 and higher levels of disability compared to White participants, but the study did not find a gender difference in pain reporting. 55,56 Limitations of this study include a small sample size; thus, findings should be considered cautiously.…”

“…One study working with middle age patients found that more than 60% used pain medication for their low back pain. 51 Our study population is younger and reported lower levels of pain, yet a higher percentage of them used pain medications compared to the previously cited study population. Similar trends were also observed in an international population with musculoskeletal pain.…”

Greater socioenvironmental risk factors and higher chronic pain stage are associated with thinner bilateral temporal lobes

“…Individual‐level socioenvironmental factors include factors such as education, income, marital status, insurance status, and number of people living in the household. Adults with greater socioenvironmental risk, that is, an income ≤$25,000, less than a high school education, no insurance or domestic partner, and/or unemployed experience more disabling pain compared to those with lower socioenvironmental risk (Allen‐Watts et al., 2021 ; Janevic et al., 2017 ; Mullins et al., 2022 ; Portenoy et al., 2004 ).…”