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.

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The present study describes the development of the Chronic Pain Self-Efficacy Scale (CPSS), a 22-item questionnaire designed to measure chronic pain patients' perceived self-efficacy to cope with the consequences of chronic pain. The CPSS and other measures of psychosocial functioning were administered to 141 consecutive patients who were referred to an outpatient multidisciplinary pain treatment program. An exploratory factor analysis of the CPSS responses identified 3 factors: self-efficacy for pain management (PSE), self-efficacy for coping with symptoms (CSE), and self-efficacy for physical function (FSE). The CPSS then was administered to a replication sample of 136 chronic pain patients. Factor analysis confirmed the 3-factor structure of the CPSS. The subscale scores derived from the factor analysis were significantly correlated with measures of depression, hopelessness, somatic preoccupation, and adaptation to the chronic pain experience. Multiple regression analyses provided further support for the concurrent and construct validity of the CPSS. The scale may aid in the evaluation of the self-efficacy beliefs of chronic pain patients.

Racial and ethnic disparities in healthcare persist in the U.S. Although pain is one of the most prevalent and disabling symptoms of disease, only a few studies have assessed disparities in pain in large racially and ethnically diverse, middle-to late aged community samples, thus limiting the generalizability of study findings in broader populations. With data from the 2000 Health and Retirement Study, we assessed the prevalence and impact of pain in a community sample of aging (≥51 years old) non-Hispanic whites (n = 11,021), non-Hispanic blacks (n = 1,804), and Hispanics (n = 952) in the U.S. Pain, pain severity, activity limitation as a result of pain, comorbid conditions, and sociodemographic variables were assessed. Results showed that pain prevalence was 28%, and 17% of the sample reported activity limitation as a result of pain. Non-Hispanic blacks (odds ratio [OR], 1.78; 99% confidence interval [CI], 1.33-2.37) and Hispanics (OR, 1.80; 99% CI, 1.26-2.56) had higher risk for severe pain compared with non-Hispanic whites. Analyses of respondents with pain (n = 3,811) showed that having chronic diseases (2 comorbid conditions, OR, 1.5; 99% CI, 1.09-2.17), psychological distress (OR, 1.99; 99% CI, 1.54-2.43), being a Medicaid recipient (OR, 1.63; 99% CI, 1.17-2.25), and lower educational level (OR, 1.45; 99% CI, 1.14-1.85) were significant predictors for severe pain and helped to explain racial/ethnic differences in pain severity.Perspective-This study, which used a large racially and ethnically diverse community sample, provided empirical evidence that racial/ethnic difference in pain severity in aging community adults in the U.S. can be accounted for by differential vulnerability in terms of chronic disease, socioeconomic conditions, and access to care. KeywordsPain; disparities; aging; epidemiology; race; ethnicity Disparities in healthcare persist for racial and ethnic minorities in the United States. 26,50, 63 Racial/ethnic minorities are at a higher risk for poorer health and shorter survival,18,22, 31 have poorer access to healthcare services,33,52 and have lower quality of healthcare.4,25 Despite the fact that pain is one of the most frequent and devastating symptoms of disease, studies on racial/ethnic differences in pain are limited.11,39,40 Most studies of racial and ethnic disparities in healthcare come from studies of diseases such as cardiovascular diseases,9,17, 34 renal diseases,12,24 cancer,10,49,62 In this study, we describe the prevalence and impact of pain in a racially and ethnically diverse, nationally representative sample of middle-to late-aged adults (older than 50 years) in the United States. Studies show that although the pattern of pain prevalence in older people is unclear,28,35 overall, aging populations are at increased risk for pain.14,58,59,74 It is generally accepted that increased pathologic load is an overriding factor contributing to increased pain complaint with advancing age,35 with older adults at a greater risk for diseases that cause pain, such as arthriti...

BACKGROUND Minority patients with cancer are at risk for undertreatment of cancer‐related pain. Most studies of patient‐related barriers to pain control have surveyed primarily non‐Hispanic Caucasian patients. The purpose of the current study was to explore barriers to optimal pain management among African‐American and Hispanic patients with cancer through the use of structured patient interviews. Structured interviews allowed the authors to probe for previously unidentified barriers to pain management in these populations. METHODS Thirty‐one socioeconomically disadvantaged minority patients with cancer (14 African‐American patients and 17 Hispanic patients) who had cancer‐related pain completed structured interviews that assessed three main content areas: information and communication regarding cancer pain, treatment of cancer pain, and the meaning of cancer pain. RESULTS The African‐American and Hispanic patients reported severe pain and many concerns about pain management. The majority of patients in both ethnic groups expressed a belief in stoicism and concerns about possible addiction to opioid medications and the development of tolerance. The patients described their physicians as the most frequent and trusted source of information about cancer pain. However, patients also reported difficulties with communication and a reluctance to complain of pain. CONCLUSIONS The reported barriers to pain management indicate that socioeconomically disadvantaged African‐American and Hispanic patients can benefit from educational interventions on cancer pain that dispel myths about opioids and teach patients to communicate assertively about their pain with their physicians and nurses. Cancer 2002;94:2295–304. © 2002 American Cancer Society. DOI 10.1002/cncr.10414