Pain and Ethnicity

Abstract

Although pain is a widespread problem, studies have found that chronic disease, psychological distress, Medicaid insurance, and lower education levels are associated with higher incidences of severe pain [2]. Undertreating pain can lead to adverse outcomes, including elevated heart rates after surgery and increased risk of myocardial infarction, ischemic stroke, and bleeding events as a result of elevated systemic vascular resistance and elevated levels of catecholamines [2]. Other consequences of uncontrolled pain include reduced mobility, loss of strength, sleep disturbances, immune system impairment, increased susceptibility to disease, and medication dependence [3].Despite the availability of effective pharmacologic and nonpharmacologic interventions and methods to manage pain, there is a significant gap between the evaluation and treatment of pain in white people and its evaluation and treatment in African American and Hispanic people [4]. Differences in pain treatment may be due to differences in needs-e.g., resulting from genetic differences-or to inequitiesunfair differences in access or opportunity, e.g., unavailability of opioids in a neighborhood [2]. Another cause of differences in treatment may be a lack of awareness among clinicians and trainees of evidence-based guidelines. Defining PainThe American Academy of Pain Medicine classifies pain as acute or chronic. In acute pain, a "one-to-one relationship exists between injury and pain," and the "pain is frequently short-lived and self-limiting" [5]. However, the pain "can become persistent and intractable if the underlying disease process or injury is chronic or incurable, or if the activation of pain is unavoidable, as in pain caused by movement or weight bearing in injuries of the spine or in diseases such as arthritis" [5]. Chronic pain is defined as pain that persists longer than three months [5]. Pain can be managed with a range or combination of treatments such as nonsteroidal antiinflammatories (NSAIDs) and other nonopioid medications, physical therapy, psychological interventions, alternative medicine, referral to a specialist, or opioids. Pharmacogenomics and PainA review of the literature on the influence of race or ethnicity on the pharmacokinetics of analgesics found that there may be differences in bioavailability, hepatic metabolism, renal secretion, protein binding, and distribution

Assessing cultural competency among Canadian chiropractors: a cross-sectional survey of Canadian Chiropractic Association members

“…Unconscious bias refers to discrimination against a group of people that we are not directly aware of that influences judgement [ 35 ]. Unconscious biases have been associated with health disparities (e.g., unequal access to care) [ 36 ]. Uncertainties expressed for the statement “I think some people have an agenda to look for discrimination even where it does not exist,” points to potential unconscious biases that may influence provision of care [ 37 ].…”

Slavery, Colonialism, and Ecological Imperialism: Insights from Stratification Economics

“…During antebellum slavery, white medical professionals argued that the bodies of Black and white individuals were fundamentally different (Villarosa 2019), resulting in racist beliefs that remain entrenched in American consciousness despite being completely unfounded and disproven. Some of these myths even continue to plague the U.S. medical system and, to this day, doctors fail to appropriately treat the pain of Black people (Mossey 2011;Wyatt 2013;Villarosa 2019;Hoffman et al 2016).…”

Demographic factors associated with length of stay in hospital and histological diagnosis in adults undergoing appendicectomy

“…Overall, whilst an association between South Asian ethnicity and prolonged length of stay for admissions with appendicectomy has been observed in this study, no definitive conclusions can be made as to reasons why this is the case. Some of these reasons, to name a few, may be a disparity in health-related knowledge between South Asians and other ethnicities, increased prevalence of certain co-morbidities (e.g., type 2 diabetes), cultural differences in attitudes to healthcare in the perioperative period (21), differences in the pharmacokinetics of antibiotics and analgesics (22), measurement of symptoms using methods that are less appropriate for certain ethnicities (e.g., pain scales not being entirely holistic). Furthermore, the causes for South Asians having increased length of stay may be different geographically and vary by local health economy.…”