Access to Care for Chronic Pain: Racial and Ethnic Differences

Social capital, trust in the health-care system and self-rated health: The role of access to health care in a population-based study

“…While one US study on trust in the medical profession failed to find any relationship between trust and demographic characteristics and socio-economic factors (Hall, Camacho, Dugan, & Balkrishnan, 2003), another US study concluded that demographic characteristics and socio-economic factors influence access to care for chronic pain (Nguyen, Ugarte, Fuller, Haas, & Portenoy, 2005).…”

Defining Racial and Ethnic Disparities in Pain Management

“…African Americans have higher levels of comorbid depression and/or anxiety, fear, and helplessness than whites [13,41,67,78] African Americans are more likely to attribute pain to personal inadequacies than whites [58] Overt behavioral expression of pain; verbal expressions; pain reporting; pain coping strategies; healthcare seeking; activity/role interference and restrictions African Americans are more likely than whites to underreport pain unpleasantness, especially in the presence of physicians perceived as ''higher social status'' [52] African Americans and Hispanics are more likely than whites to believe health professionals did not believe them when they reported being in pain [74] African Americans experience greater activity interference at comparable pain level than whites or Hispanics [6,48,50,51,61] African Americans are more likely to use passive pain coping strategies (prayer, pain catastrophizing) [41,92] African Americans and Hispanics are more afraid than whites of opioid addiction risk [3,23] Volume 469, Number 7, July 2011 Racial/Ethnic Disparities in Pain Management 1863 recognized knowledge regarding pain conditions and pain management principles and strategies, especially the pharmacology and prescribing guides for pain medications, are not well covered in medical undergraduate and specialty education. Physicians' lack of such knowledge and the resultant discomfort in pain management skill level have been advanced as important contributors to the observed racial/ethnic disparities [2,13,100].…”

“…With no time limits to complete the study tasks, the physicians were asked to formulate a treatment plan that included pain management. The common finding from these studies was the absence of an association between the patient's race and the physician's planned medication prescribing patterns [71,74,104]. Because of the structured, impersonal nature of the task and the availability of sufficient time to carefully weigh different alternatives, vignette studies stimulate ''rule-based'' social cognitive processing.…”

Racial discrimination in pain management

“…Meaning and behavior may be associated to cultural rules, and perception and communication may be impaired when health professional and patient ethnicities are different. Although differences in pain management based on race and ethnicity are common themes in pain studies, there is little evidence to explain why these differences exist 24 . Possible explanations include heath caregivers' racism, language and cultural barrier impairing communication, socioeconomic factors which affect ethnic minorities and gaps in the understanding how to reliably evaluate pain.…”

“…Until such aspects are not further understood, it will be difficult to develop strategies to eliminate ethnic and racial differences in pain management 2 . Research on culturally and linguistically-sensitive pain evaluation tools and studies about quality assistance of social and ethnic minorities experiencing pain are needed 24 . Authors suggest that one initiative to minimize racial discrimination in pain management could be the implementation of protocols to assist patients in health services 58 .…”