Reducing Disparities in Pain Management in Primary Care
-
Pallav Dave
Regulatory Compliance Analyst, Louisville, KY,40223, USA
editor.jddt@gmail.com
Abstract
Pain is a healthcare challenge impacting millions of people in the US. On average, 50 million people live with chronic pain in the US. Reducing disparities in pain management is important. Pain has a devastating impact on patients, affecting physical and mental functioning. It also affects patients’ quality of life. Patients who experience pain report limitations in doing activities, restriction on mobility, lost work productivity, higher anxiety levels, depression, increased suicidal risk, and more likelihood of abusing and misusing substances. Racial and gender disparities have been reported in managing pain in primary care. African Americans, Hispanics, and other racial minorities report poor management of pain than whites. Socioeconomic factors also contribute to pain disparities. Being less educated, having lower income levels, lower levels of education, and lacking medical insurance have been associated with poor management of pain. Addressing these disparities can improve pain outcomes. Improving patient-provider communication, making systematic and structural changes, shared-decision making, using a multi-disciplinary approach, and tailoring pain management approaches to specific patient needs are some of the measures that can reduce disparities in managing pain.
Keywords:
pain, chronic pain, disparities, pain management, primary care
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References
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5. Morales ME, Yong RJ. Racial and ethnic disparities in the treatment of chronic pain. Pain Medicine. 2021 Jan 1;22(1):75-90.doi:10.1093/pm/pnaa427
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7. Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. The journal of pain. 2015 Aug 1;16(8):769-80.doi:10.1016/j.jpain.2015.05.002
8. Nahin RL. Pain prevalence, chronicity and impact within subpopulations based on both hispanic ancestry and race: United States, 2010-2017. The Journal of Pain. 2021;22(7):826-51.doi:10.1016/j.jpain.2021.02.006
9. Jimenez N, Garroutte E, Kundu A, Morales L, Buchwald D. A review of the experience, epidemiology, and management of pain among American Indian, Alaska Native, and Aboriginal Canadian peoples. The Journal of Pain. 2011;12(5):511-22.doi:10.1016/j.jpain.2010.12.002
10. Zajacova A, Grol-Prokopczyk H, Zimmer Z. Pain trends among American adults, 2002–2018: patterns, disparities, and correlates. Demography. 2021;58(2):711-38.doi: 10.1215/00703370-8977691
11. Rasu RS, Knell ME. Determinants of opioid prescribing for nonmalignant chronic pain in US outpatient settings. Pain Medicine. 2018;19(3):524-32. doi:10.1093/pm/pnx025
12. Ly DP. Racial and ethnic disparities in the evaluation and management of pain in the outpatient setting, 2006-2015. Pain Medicine. 2019;20(2):223-32.doi:10.1093/pm/pny074
13. LeResche L. Defining gender disparities in pain management. Clinical Orthopaedics and Related Research®. 2011;469(7):1871-7.DOI 10.1007/s11999-010-1759-9
14. Mullins PM, Yong RJ, Bhattacharyya N. Impact of demographic factors on chronic pain among adults in the United States. Pain Reports. 2022;7(4):e1009.doi:10.1097/PR9.0000000000001009
15. Campbell CM, Edwards RR. Ethnic differences in pain and pain management. Pain Management. 2012;2(3):219-30.doi:10.2217/pmt.12.7
16. Janevic MR, McLaughlin SJ, Heapy AA, Thacker C, Piette JD. Racial and socioeconomic disparities in disabling chronic pain: findings from the health and retirement study. The Journal of Pain. 2017;18(12):1459-67.doi:10.1016/j.jpain.2017.07.005
17. Ezenwa M, Fleming M. Racial disparities in pain management in primary care. The Journal of Pain. 2012;13(4):S20.
18. Nguyen M, Ugarte C, Fuller I, Haas G, Portenoy RK. Access to care for chronic pain: racial and ethnic differences. The Journal of Pain. 2005;6(5):301-14.doi:10.1016/j.jpain.2004.12.008
19. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences. 2016;113(16):4296-301.doi:10.1073/pnas.1516047113
20. Hollingshead NA, Vrany EA, Stewart JC, Hirsh AT. Differences in Mexican Americans’ prevalence of chronic pain and co-occurring analgesic medication and substance use relative to non-Hispanic White and Black Americans: results from NHANES 1999–2004. Pain Medicine. 2016;17(6):1001-9.doi:10.1093/pm/pnv003
21. Meghani SH, Cho E. Self‐reported pain and utilization of pain treatment between minorities and nonminorities in the United States. Public Health Nursing. 2009;26(4):307-16.doi:10.1111/j.1525-1446.2009.00785.x
22. Badreldin N, Grobman WA, Yee LM. Racial disparities in postpartum pain management. Obstetrics & Gynecology. 2019;134(6):1147-53.doi:10.1097/AOG.0000000000003561
23. Johnson JD, Asiodu IV, McKenzie CP, Tucker C, Tully KP, Bryant K, Verbiest S, Stuebe AM. Racial and ethnic inequities in postpartum pain evaluation and management. Obstetrics & Gynecology. 2019;134(6):1155-62.doi:10.1097/AOG.0000000000003505.
24. Joynt M, Train MK, Robbins BW, Halterman JS, Caiola E, Fortuna RJ. The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. Journal of General Internal Medicine. 2013;28:1604-10.doi:10.1007/s11606-013-2516-z
25. Prunuske JP, St. Hill CA, Hager KD, et al. Opioid prescribing patterns for non-malignant chronic pain for rural versus non-rural US adults: a population-based study using 2010 NAMCS data. BMC Health Services Research.2014;14:1-8.doi:10.1186/s12913-014-0563-8.
26. Goode AP, Freburger JK, Carey TS. The influence of rural versus urban residence on utilization and receipt of care for chronic low back pain. The Journal of Rural Health. 2013;29(2):205-14.doi:10.1111/j.1748-0361.2012.00436.x.
27. Meints SM, Cortes A, Morais CA, Edwards RR. Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Management. 2019;9(3):317-34.doi:10.2217/pmt-2018-0030
28. Meints SM, Miller MM, Hirsh AT. Differences in pain coping between black and white Americans: a meta-analysis. The Journal of Pain. 2016;17(6):642-53.doi:10.1016/j.jpain.2015.12.017
29. Severeijns R, Vlaeyen JW, van den Hout MA, Weber WE. Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. The Clinical journal of pain. 2001;17(2):165-72.
30. Edwards RR, Moric M, Husfeldt B, Buvanendran A, Ivankovich O. Ethnic similarities and differences in the chronic pain experience: a comparison of African American, Hispanic, and white patients. Pain Medicine. 2005;6(1):88-98.doi:10.1111/j.1526-4637.2005.05007.x
31. Gagnon CM, Matsuura JT, Smith CC, Stanos SP. Ethnicity and interdisciplinary pain treatment. Pain Practice. 2014;14(6):532-40. doi:10.1111/papr.12102
32. Staton LJ, Panda M, Chen I, et al., When race matters: disagreement in pain perception between patients and their physicians in primary care. Journal of the National Medical Association. 2007;99(5):532.
33. Pallav Dave, Recommendations for Pain Management in Cancer Patients Asian Journal of Pharmaceutical Research and Development. 2024; 12(2):7-12. DOI: https://doi.org/10.22270/ajprd.v12i2.1339
34. Becker WC, Starrels JL, Heo M, Li X, Weiner MG, Turner BJ. Racial differences in primary care opioid risk reduction strategies. The Annals of Family Medicine. 2011;9(3):219-25.doi:10.1370/afm.1242.
35. Buonora M, Perez HR, Heo M, Cunningham CO, Starrels JL. Race and gender are associated with opioid dose reduction among patients on chronic opioid therapy. Pain Medicine. 2019;20(8):1519-27.doi:10.1093/pm/pny137
36. Thurston KL, Zhang SJ, Wilbanks BA, Billings R, Aroke EN. A systematic review of race, sex, and socioeconomic status differences in postoperative pain and pain management. Journal of PeriAnesthesia Nursing. 2023;38(3):504-15.doi:10.1016/j.jopan.2022.09.004
37. Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Medicine. 2003;4(3):277-94.doi:10.1046/j.1526-4637.2003.03034.x
38. Henry SG, Matthias MS. Patient-clinician communication about pain: a conceptual model and narrative review. Pain Medicine. 2018;19(11):2154-65.doi:10.1093/pm/pny003.
39. Dorflinger L, Kerns RD, Auerbach SM. Providers' roles in enhancing patients' adherence to pain self management. Translational Behavioral Medicine. 2013;3(1):39-46.doi:10.1007/s13142-012-0158-z
40. Jacobsen R, Møldrup C, Christrup L, Sjøgren P. Patient‐related barriers to cancer pain management: a systematic exploratory review. Scandinavian Journal of Caring Sciences. 2009;23(1):190-208. doi:10.1111/j.1471-6712.2008.00601.x
41. Frantsve LM, Kerns RD. Patient–provider interactions in the management of chronic pain: current findings within the context of shared medical decision making. Pain Medicine. 2007 ;8(1):25-35.doi:10.1111/j.1526-4637.2007.00250.x
42. Andreae MH, White RS, Chen KY, Nair S, Hall C, Shaparin N. The effect of initiatives to overcome language barriers and improve attendance: a cross-sectional analysis of adherence in an inner city chronic pain clinic. Pain Medicine. 2017;18(2):265-74. doi: 10.1093/pm/pnw161
43. Andreae MH, Nair S, Gabry JS, Goodrich B, Hall C, Shaparin N. A pragmatic trial to improve adherence with scheduled appointments in an inner-city pain clinic by human phone calls in the patient's preferred language. Journal of Clinical Anesthesia. 2017;42:77-83.doi:10.1016/j.jclinane.2017.08.014
44. Wang ML, Jacobs O. From Awareness to Action: Pathways to Equity in Pain Management. Health Equity. 2023;7(1):416-8.doi:10.1089/heq.2023.0179
45. Knoebel RW, Starck JV, Miller P. Treatment disparities among the Black population and their influence on the equitable management of chronic pain. Health Equity. 2021;5(1):596-605.doi:10.1089/heq.2020.0062
46. Merry B, Edwards RR, Buenaver LF, et al. Ethnic group differences in the outcomes of multidisciplinary pain treatment. Journal of Musculoskeletal Pain. 2011;19(1):24-30.doi:10.3109/10582452.2010.538821
2. Nahin RL, Feinberg T, Kapos FP, Terman GW. Estimated rates of incident and persistent chronic pain among US adults, 2019-2020. JAMA Network Open. 2023;6(5):e2313563.doi:10.1001/jamanetworkopen.2023.13563
3. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain -United States, 2022. MMWR Recommendations and Reports. 2022;71(No. RR-3):1–95. doi:10.15585/mmwr.rr7103a1.
4. Rikard SM, Strahan AE, Schmit KM, Guy GP Jr.Chronic Pain Among Adults-United States, 2019–2021. MMWR. Morbidity and Mortality Weekly Report2023;72:379–385.doi:10.15585/mmwr.mm7215a1
5. Morales ME, Yong RJ. Racial and ethnic disparities in the treatment of chronic pain. Pain Medicine. 2021 Jan 1;22(1):75-90.doi:10.1093/pm/pnaa427
6. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press; 2011
7. Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. The journal of pain. 2015 Aug 1;16(8):769-80.doi:10.1016/j.jpain.2015.05.002
8. Nahin RL. Pain prevalence, chronicity and impact within subpopulations based on both hispanic ancestry and race: United States, 2010-2017. The Journal of Pain. 2021;22(7):826-51.doi:10.1016/j.jpain.2021.02.006
9. Jimenez N, Garroutte E, Kundu A, Morales L, Buchwald D. A review of the experience, epidemiology, and management of pain among American Indian, Alaska Native, and Aboriginal Canadian peoples. The Journal of Pain. 2011;12(5):511-22.doi:10.1016/j.jpain.2010.12.002
10. Zajacova A, Grol-Prokopczyk H, Zimmer Z. Pain trends among American adults, 2002–2018: patterns, disparities, and correlates. Demography. 2021;58(2):711-38.doi: 10.1215/00703370-8977691
11. Rasu RS, Knell ME. Determinants of opioid prescribing for nonmalignant chronic pain in US outpatient settings. Pain Medicine. 2018;19(3):524-32. doi:10.1093/pm/pnx025
12. Ly DP. Racial and ethnic disparities in the evaluation and management of pain in the outpatient setting, 2006-2015. Pain Medicine. 2019;20(2):223-32.doi:10.1093/pm/pny074
13. LeResche L. Defining gender disparities in pain management. Clinical Orthopaedics and Related Research®. 2011;469(7):1871-7.DOI 10.1007/s11999-010-1759-9
14. Mullins PM, Yong RJ, Bhattacharyya N. Impact of demographic factors on chronic pain among adults in the United States. Pain Reports. 2022;7(4):e1009.doi:10.1097/PR9.0000000000001009
15. Campbell CM, Edwards RR. Ethnic differences in pain and pain management. Pain Management. 2012;2(3):219-30.doi:10.2217/pmt.12.7
16. Janevic MR, McLaughlin SJ, Heapy AA, Thacker C, Piette JD. Racial and socioeconomic disparities in disabling chronic pain: findings from the health and retirement study. The Journal of Pain. 2017;18(12):1459-67.doi:10.1016/j.jpain.2017.07.005
17. Ezenwa M, Fleming M. Racial disparities in pain management in primary care. The Journal of Pain. 2012;13(4):S20.
18. Nguyen M, Ugarte C, Fuller I, Haas G, Portenoy RK. Access to care for chronic pain: racial and ethnic differences. The Journal of Pain. 2005;6(5):301-14.doi:10.1016/j.jpain.2004.12.008
19. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences. 2016;113(16):4296-301.doi:10.1073/pnas.1516047113
20. Hollingshead NA, Vrany EA, Stewart JC, Hirsh AT. Differences in Mexican Americans’ prevalence of chronic pain and co-occurring analgesic medication and substance use relative to non-Hispanic White and Black Americans: results from NHANES 1999–2004. Pain Medicine. 2016;17(6):1001-9.doi:10.1093/pm/pnv003
21. Meghani SH, Cho E. Self‐reported pain and utilization of pain treatment between minorities and nonminorities in the United States. Public Health Nursing. 2009;26(4):307-16.doi:10.1111/j.1525-1446.2009.00785.x
22. Badreldin N, Grobman WA, Yee LM. Racial disparities in postpartum pain management. Obstetrics & Gynecology. 2019;134(6):1147-53.doi:10.1097/AOG.0000000000003561
23. Johnson JD, Asiodu IV, McKenzie CP, Tucker C, Tully KP, Bryant K, Verbiest S, Stuebe AM. Racial and ethnic inequities in postpartum pain evaluation and management. Obstetrics & Gynecology. 2019;134(6):1155-62.doi:10.1097/AOG.0000000000003505.
24. Joynt M, Train MK, Robbins BW, Halterman JS, Caiola E, Fortuna RJ. The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. Journal of General Internal Medicine. 2013;28:1604-10.doi:10.1007/s11606-013-2516-z
25. Prunuske JP, St. Hill CA, Hager KD, et al. Opioid prescribing patterns for non-malignant chronic pain for rural versus non-rural US adults: a population-based study using 2010 NAMCS data. BMC Health Services Research.2014;14:1-8.doi:10.1186/s12913-014-0563-8.
26. Goode AP, Freburger JK, Carey TS. The influence of rural versus urban residence on utilization and receipt of care for chronic low back pain. The Journal of Rural Health. 2013;29(2):205-14.doi:10.1111/j.1748-0361.2012.00436.x.
27. Meints SM, Cortes A, Morais CA, Edwards RR. Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Management. 2019;9(3):317-34.doi:10.2217/pmt-2018-0030
28. Meints SM, Miller MM, Hirsh AT. Differences in pain coping between black and white Americans: a meta-analysis. The Journal of Pain. 2016;17(6):642-53.doi:10.1016/j.jpain.2015.12.017
29. Severeijns R, Vlaeyen JW, van den Hout MA, Weber WE. Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. The Clinical journal of pain. 2001;17(2):165-72.
30. Edwards RR, Moric M, Husfeldt B, Buvanendran A, Ivankovich O. Ethnic similarities and differences in the chronic pain experience: a comparison of African American, Hispanic, and white patients. Pain Medicine. 2005;6(1):88-98.doi:10.1111/j.1526-4637.2005.05007.x
31. Gagnon CM, Matsuura JT, Smith CC, Stanos SP. Ethnicity and interdisciplinary pain treatment. Pain Practice. 2014;14(6):532-40. doi:10.1111/papr.12102
32. Staton LJ, Panda M, Chen I, et al., When race matters: disagreement in pain perception between patients and their physicians in primary care. Journal of the National Medical Association. 2007;99(5):532.
33. Pallav Dave, Recommendations for Pain Management in Cancer Patients Asian Journal of Pharmaceutical Research and Development. 2024; 12(2):7-12. DOI: https://doi.org/10.22270/ajprd.v12i2.1339
34. Becker WC, Starrels JL, Heo M, Li X, Weiner MG, Turner BJ. Racial differences in primary care opioid risk reduction strategies. The Annals of Family Medicine. 2011;9(3):219-25.doi:10.1370/afm.1242.
35. Buonora M, Perez HR, Heo M, Cunningham CO, Starrels JL. Race and gender are associated with opioid dose reduction among patients on chronic opioid therapy. Pain Medicine. 2019;20(8):1519-27.doi:10.1093/pm/pny137
36. Thurston KL, Zhang SJ, Wilbanks BA, Billings R, Aroke EN. A systematic review of race, sex, and socioeconomic status differences in postoperative pain and pain management. Journal of PeriAnesthesia Nursing. 2023;38(3):504-15.doi:10.1016/j.jopan.2022.09.004
37. Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Medicine. 2003;4(3):277-94.doi:10.1046/j.1526-4637.2003.03034.x
38. Henry SG, Matthias MS. Patient-clinician communication about pain: a conceptual model and narrative review. Pain Medicine. 2018;19(11):2154-65.doi:10.1093/pm/pny003.
39. Dorflinger L, Kerns RD, Auerbach SM. Providers' roles in enhancing patients' adherence to pain self management. Translational Behavioral Medicine. 2013;3(1):39-46.doi:10.1007/s13142-012-0158-z
40. Jacobsen R, Møldrup C, Christrup L, Sjøgren P. Patient‐related barriers to cancer pain management: a systematic exploratory review. Scandinavian Journal of Caring Sciences. 2009;23(1):190-208. doi:10.1111/j.1471-6712.2008.00601.x
41. Frantsve LM, Kerns RD. Patient–provider interactions in the management of chronic pain: current findings within the context of shared medical decision making. Pain Medicine. 2007 ;8(1):25-35.doi:10.1111/j.1526-4637.2007.00250.x
42. Andreae MH, White RS, Chen KY, Nair S, Hall C, Shaparin N. The effect of initiatives to overcome language barriers and improve attendance: a cross-sectional analysis of adherence in an inner city chronic pain clinic. Pain Medicine. 2017;18(2):265-74. doi: 10.1093/pm/pnw161
43. Andreae MH, Nair S, Gabry JS, Goodrich B, Hall C, Shaparin N. A pragmatic trial to improve adherence with scheduled appointments in an inner-city pain clinic by human phone calls in the patient's preferred language. Journal of Clinical Anesthesia. 2017;42:77-83.doi:10.1016/j.jclinane.2017.08.014
44. Wang ML, Jacobs O. From Awareness to Action: Pathways to Equity in Pain Management. Health Equity. 2023;7(1):416-8.doi:10.1089/heq.2023.0179
45. Knoebel RW, Starck JV, Miller P. Treatment disparities among the Black population and their influence on the equitable management of chronic pain. Health Equity. 2021;5(1):596-605.doi:10.1089/heq.2020.0062
46. Merry B, Edwards RR, Buenaver LF, et al. Ethnic group differences in the outcomes of multidisciplinary pain treatment. Journal of Musculoskeletal Pain. 2011;19(1):24-30.doi:10.3109/10582452.2010.538821
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Dave, P. (2024). Reducing Disparities in Pain Management in Primary Care. Asian Journal of Hospital Pharmacy, 4(2), 28-33. https://doi.org/10.38022/ajhp.v4i2.84
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