The Unique and Interactive Effects of Patient Race, Patient Socioeconomic Status, and Provider Attitudes on Chronic Pain Care Decisions

Abstract

Background Compared to White and high socioeconomic status (SES) patients, Black and low SES patients receive less adequate pain care. Providers may contribute to these disparities by making biased decisions that are driven, in part, by their attitudes about race and SES. Purpose We examined the effects of patient race and SES on providers’ chronic pain decisions and the extent to which providers’ implicit and explicit attitudes about race and SES were related to these decisions. Methods Physician residents/fellows (n = 436) made pain care decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Physicians also completed measures assessing implicit and explicit attitudes about race and SES. Results There were three significant race-by-SES interactions: (a) For high SES patients, Black (vs. White) patients were rated as having more pain interference; the opposite race difference emerged for low SES patients. (b) For high SES patients, Black (vs. White) patients were rated as being in greater distress; no race difference emerged for low SES patients. (c) For low SES patients, White (vs. Black) patients were more likely to be recommended workplace accommodations; no race difference emerged for high SES patients. Additionally, providers were more likely to recommend opioids to Black (vs. White) and low (vs. high) SES patients, and were more likely to use opioid contracts with low (vs. high) SES patients. Providers’ implicit and explicit attitudes predicted some, but not all, of their pain-related ratings. Conclusion These results highlight the need to further examine the effects of patient race and SES simultaneously in the context of pain care.

Best practices for virtual care to support youth with chronic pain and their families: a rapid systematic review to inform health care and policy during COVID-19 and beyond

“…In addition, much of the research contributing to this review may disproportionately represent White populations. To address this, our group is seeking input regarding the best practices for virtual care identified here with specific groups at-risk for inequities in chronic pain care, 1 , 23 including Black youth living with sickle cell disease, 40 , 77 indigenous youth with chronic pain, 45 , 50 , 83 and youth with medical complexities 6 and their families. Stepped care approaches to chronic pain care are increasingly recommended, 2 , 19 , 60 as are potential hub-and-spoke models, 28 to reach rural and remote communities.…”

“…In light of the current COVID-19 pandemic, the chronic pain crisis, and the rapid shift to the use of virtual care, 1 , 2 it is essential that existing evidence-based virtual care recommendations are identified to guide practice. The results of this systematic review should be used to inform ongoing decision making by health professional, decision makers, and policymakers regarding best practices for virtual delivery of chronic pain care for youth and their families.…”

How and Why Patient Concerns Influence Pain Reporting: A Qualitative Analysis of Personal Accounts and Perceptions of Others’ Use of Numerical Pain Scales

“…Previous studies indicate that health care providers tend to think patients are in less pain than they report ( Guru and Dubinsky, 2000 ; Marquié et al, 2003 ). Implicit biases ( Staton et al, 2007 ; Anastas et al, 2020 ) and attribution of higher pain reports to drug-seeking motivations ( Buchman et al, 2016 ) may compound these effects and subsequently contribute to pain treatment disparities. Together, these perceptions influence treatment decisions that can negatively impact patients’ health and well-being ( Bartfield et al, 1997 ; Woo et al, 2017 ) and likely reinforce pain stigma more generally ( Goldberg, 2017 ).…”

Mechanisms of injustice: what we (do not) know about racialized disparities in pain

“…Second, research has identified bias in pain assessment and treatment recommendations, providing consistent evidence that provider appraisals are not independent of patients' racialized, socioeconomic, and sex identities. 2,[46][47][48]61,67,75,97 Emerging research (albeit outside the field of pain) has identified specific provider bias-related behaviors which undermine patient interactions, such as reduced eye contact, specific word choices, and condescending tone and pitch. 41 Although such research is critical to effect change and has contributed to some improvements in care for minoritized groups, it is limited in volume and scope and has been largely divorced from consideration of cultural or structural injustice domains.…”