The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain

Abstract

A B S T R A C TContext. Pain has significant socioeconomic, health, and quality-of-life implications. Racial-and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites.Objectives. To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racialand ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided.Evidence. A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication.Conclusions. Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities.

Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

“…Whether he receives the standard of care that he expects, however, is likely contingent on his race/ethnicity. Prior research suggests that if he is black, then his pain will likely be underestimated and undertreated compared with if he is white (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). The present work investigates one potential factor associated with this racial bias.…”

“…The first possibility is that physicians recognize black patients' pain, but do not to treat it, perhaps due to concerns about noncompliance or access to health care (7,8). The second possibility is that physicians do not recognize black patients' pain in the first place, and thus cannot treat it.…”

“…Extant research has shown that, relative to white patients, black patients are less likely to be given pain medications and, if given pain medications, they receive lower quantities (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). For example, in a retrospective study, Todd et al (10) found that black patients were significantly less likely than white patients to receive analgesics for extremity fractures in the emergency room (57% vs. 74%), despite having similar self-reports of pain.…”

Health domains and race in generic preference-based health-related quality of life instruments in the United States literature

“…There are significant gaps in the literature about the pain experiences of persons of racial minorities (GREEN et al, 2003) and there is also growing interest in understanding the influence of race and ethnicity on the experience of pain (EDWARDS et al, 2001b;EDWARDS;KEEFE, 2001). Investigators have recently indicated that African Americans report greater levels of pain than whites for conditions such as glaucoma, AIDS, migraine headache, jaw pain, postoperative pain, myofascial pain, angina pectoris, joint pain, nonspecific daily pain and arthritis (EDWARDS et al, 2001).…”

“…Overall, little is known about what influences differences in pain-related quality of life and further investigation is needed to understand racial differences in pain (GREEN et al, 2003).…”