The relationship between patients’ income and education and their access to pharmacological chronic pain management: A scoping review

Abstract

Background Though chronic pain is widespread, affecting about one-fifth of the world’s population, its impacts are disproportionately felt across the population according to socioeconomic determinants such as education and income. These factors also influence patients’ access to treatment, including pharmacological pain management. Aim A scoping review was undertaken to better understand the association of socioeconomic factors with physicians’ pain management prescribing patterns for adults living with chronic pain. Methods An electronic literature search was conducted using the EMBASE, CINAHL, SCOPUS, and Ovid MEDLINE databases and 31 retrieved articles deemed relevant for analyses were critically appraised. Results The available evidence indicates that patients’ lower socioeconomic status is associated with a greater likelihood of being prescribed opioids to manage their chronic pain and a decreased likelihood of receiving prescription medications to manage migraines, rheumatoid arthritis, and osteoarthritis. Conclusions These results suggest that individuals with lower socioeconomic status do not receive equal prescription medicine opportunities to manage their chronic pain conditions. This is influenced by a variety of intersecting variables, including access to care, the potential unaffordability of certain therapies, patients’ health literacy, and prescribing biases. Future research is needed to identify interventions to improve equity of access to therapies for patients with chronic pain living in lower socioeconomic situations as well as to explain the mechanism through which socioeconomic status affects chronic pain treatment choices by health care providers. Abbreviation SES: socioeconomic status; RA: rheumatoid arthritis; IV: intravenous; SC: subcutaneous; bDMARDs: biological disease-modifying antirheumatic drugs; DMARDS; disease-modifying antirheumatic drugs; TNFi: tumour necrosis factor inhibitors; NSAIDs: non-steroidal anti-inflammatory drugs

Osteoarthritis Literacy and Equity Issues: A Post COVID-19 Analysis and Update

“…As well, while laudable efforts have been put forth to bridge the service gap since 2019, following remotely staged exercise regimens or others-not designed for the particular client, as well exposure to media messages advocating technological appliances that may do little to stem the disease progression, may do more harm than good if the individual is unable to separate fact from fiction. In addition needed possible home based safety modifications, medication checks, and the purchase of assistive devices may be very challenging to undertake for many in the higher age ranges who not only have multiple affected joint sites and medical conditions, but are unable to articulate or access the help needed without appropriate assistance and guidance and discussions with the key provider [37].…”

“…In this regard, a one size fits all approach may fail unless if the older adult is guided thoughtfully by the provider in light of their prevailing health status, as well as any mediating or possibly moderating epigenetic factors [37,38]. These understandings might include explanations about the specific importance of energy conservation and desirable sleep hygiene practices including physical activity participation in efforts to relieve pain, fatigue, and stiffness, and lessening reliance on medications, particularly during the early disease stages [34].…”

“…These understandings might include explanations about the specific importance of energy conservation and desirable sleep hygiene practices including physical activity participation in efforts to relieve pain, fatigue, and stiffness, and lessening reliance on medications, particularly during the early disease stages [34]. As well, heightened attention is currently indicated as far as creating personalized culturally relevant infection protection strategies, as well as nutritional and exercise approaches that respect affordability and access issues, along with their ability to act on these recommendations [37]. That is, the clinician or team of providers must currently be in a position, as well as motivated to conduct and undertake a thorough medical history, a comprehensive physical examination, plus a detailed environmental assessment of the older adults' key needs before ascertaining the precise intervention aims and design.…”

“…In short, a significant proportion of those older adults who wish to continue live independently in the community rather than the nursing home and who may suffer many challenges due to their osteoarthritis may yet tend to be better off in response to active efforts to optimize joint biomechanics and life quality and self-efficacy than not. However, they may be worse off if they cannot comprehend what they need to do and why, and have multiple associated social challenges as well as economic challenges, even if surgery is forthcoming [37,38]. A role for prior educational inequities that may heighten the disease burden should also be borne in mind by the provider in this respect.…”

Oral Glucocorticoid Use and Long-Term Mortality in Patients with Chronic Musculoskeletal Non-Cancer Pain: A Cross-Sectional Cohort Study

“…Data on age and sex were extracted as demographic information. Information on employment status, household income level, and place of residence was collected to determine the socioeconomic status of patients with CNCP because socioeconomic status could affect pharmacological treatment in patients with CNCP [17]. Information on household income level was included in the NHIS database to determine the insurance premiums of the South Korean population.…”