Undertreatment of pain resulting in physiological, psychosocial, and economic consequences continues despite targeted improvement approaches. Starck et al. propose a systems framework for study of pain management errors. This secondary analysis examined pain outcomes of hospitalized inpatients to determine factors predicting adequate pain management. Data were collected from 964 hospitalized adult patients in the southwestern United States. The American Pain Society Patient Outcome Questionnaire and a demographic and chart audit form were used to collect data. The Pain Management Index (PMI) was computed for all participants. Results revealed that 30% of patients were undertreated for pain, with 67.5% reporting severe worst pain ratings (7 on a 0-10 scale). Non-whites, the elderly, and women had significantly higher pain ratings and higher proportions of negative PMI scores. Logistic regression predicted adequate pain management based on analgesic rating, ethnicity, age, and educational level with 0.89 accuracy. The study findings support conceptualizing mismanagement of pain as a medical error. An intervention model describes the use of a systems approach to identify high risk patients and ensure effective pain management practices for all.

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As a primarily subjective phenomenon, pain expression may vary among different populations. Patients from minority populations may be more likely to have poor pain management, less analgesia prescribed, and lower doses administered for their pain. To understand better the Hispanic pain experience, qualitative methods were used to gather data from postoperative adult Hispanic patients in both an urban and rural setting regarding their perspective and response to the pain experience. Descriptive qualitative analysis of interview data from a sample (n=35) of predominantly female, married and Catholic respondents, ranging in age from 23-80 years yielded five categories: Characteristics of the pain experience; Managing pain; Information about pain; Interactions with providers, and Cultural considerations. Several themes defined each category and were used in a larger study to develop a Spanish language instrument to measure pain outcomes. Descriptions of the categories and themes and implications for further research and clinical care are presented. For Hispanic populations, cultural issues having an impact on research regarding pain, such as simpatia (a striving for harmonious relationships without interpersonal conflict), respect, and family involvement, as well as problems with recruitment of minority patients to research studies, must be addressed to improve the effectiveness of pain management for this group.

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