Patients belonging to some racial, ethnic, and socioeconomic groups are at risk of receiving suboptimal pain management. This study identifies health care provider attitudes, knowledge, and practices regarding the treatment of chronic pain in vulnerable patient populations and assesses whether a certified continuing medical education (CME) intervention can improve knowledge in this area. Survey responses revealed several knowledge gaps, including a lack of knowledge that the undertreatment of pain is more common in minority patients than others. Respondents identified language barriers, miscommunication, fear of medication diversion, and financial barriers as major obstacles to optimal pain management for this patient population. Participants who completed a CME-certified activity on pain management disparities demonstrated increased confidence in caring for disadvantaged patients, but only 1 of 3 knowledge items improved. Understanding clinician factors that underlie suboptimal pain management is necessary to develop effective strategies to overcome disparities and improve quality of care for patients with chronic pain.

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Not to diminish the value of this book, but as fair criticism, what I missed in this otherwise comprehensive treatment of the subject was some discussion about innovative models of care and the outcomes of educational efforts to improve cancer pain assessment and management in routine cancer care settings. For all that is known and written about, we are still challenged mightily by the seemingly low priority given to pain, despite (almost) universal agreement that it is important and such a significant burden to patients and their families. Although empirically sound information on what certain individual clinicians, clinical groups, and health care systems have done successfully is difficult to amass, it would have been useful to know what models of practice have been cost-effective, in summary form, to improve on the status quo. That said, order the book: operators are standing by!

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