A Multifaceted Initiative to Improve Clinician Awareness of Pain Management Disparities

Abstract

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.

Pain Interference, Psychopathology, and General Medical Conditions Among Black and White Adults in the US General Population

“…The strong associations across study groups between moderate or severe pain interference and a range of Axis-I disorders as well as general medical conditions emphasize the importance of the routine assessment of psychopathology in patients with pain interference and, conversely, pain interference in patients seeking treatment for psychiatric disorders. Our findings underscore those from prior studies indicating that further investigation of race-related differences in pain interference is warranted, including systematic examination of the extent to which these differences are mediated or moderated by socioeconomic status and other factors (e.g., stress, access to healthcare, genetics) (Portenoy et al, 2004, Meghani et al, 2012, Bekanich et al, 2014, Robbins et al, 2015). …”

Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency Department

“…Programs that may help include empathy training, communicating about expectations of pain relief in the ED, and cross-cultural training. 3 , 26 There is a dearth of evidence, however, that cross-cultural training actually reduces racial/ethnic healthcare disparities. 28 , 29 Awareness of and learning about implicit bias and how it operates in clinical settings is needed in undergraduate, graduate, and postgraduate programs to improve racial disparities.…”

“… 28 , 29 Awareness of and learning about implicit bias and how it operates in clinical settings is needed in undergraduate, graduate, and postgraduate programs to improve racial disparities. 26 , 28 Richardson et al 31 suggests quality improvement programs such as periodic retrospective review of ED physician data on points of known disparate care so that physicians can be more cognizant of any implicit bias. In addition, a multidisciplinary approach using techniques from social and psychological science research could help to inform clinical educators and practicing physicians on the nuances of stereotypes and ways to overcome implicit bias.…”

Addressing Obstacles to Evidence-Informed Pain Care

“…Research also shows that African Americans are likely to have their pain intensity underestimated by primary care clinicians, and pharmacies located in minority areas are less likely to carry adequate stocks of analgesic medications. 30,31,32 Opioid Prescribing and the Centers for Disease Control and Prevention Guidelines Unfortunately, one effort to decrease opioid-related harms has had the unintended consequence of encouraging rigid limits on opioid prescribing and of some patients' opioids being involuntarily discontinued or reduced inappropriately. In 2016, the Centers for Disease Control and Prevention (CDC) published a Guideline for Prescribing Opioids for Chronic Pain with the intent of providing voluntary prescribing guidelines to primary care physicians.…”