Time to Take Stock: A Meta-Analysis and Systematic Review of Analgesic Treatment Disparities for Pain in the United States

Abstract

Our study quantifies the magnitude of analgesic treatment disparities in subgroups of minorities. The size of the difference was sufficiently large to raise not only normative but quality and safety concerns. The treatment gap does not appear to be closing with time or existing policy initiatives. A concerted strategy is needed to reduce pain care disparities within the larger quality of care initiatives.

(225) Differences in Mexican Americans’ prevalence of chronic pain and co-occurring analgesic medication and substance use relative to Non-Hispanic White and Black Americans: Results from NHANES 1999-2004

“…Potentially meaningful racial/ethnic differences in opioid use observed in this investigation may have failed to reach statistical significance due to relatively low cell counts that resulted in insufficient statistical power. Our results may diverge from other studies that found evidence of opioid treatment disparities, including a 2012 meta-analysis, [14] because of differences in data collection methods. Previous investigations that found evidence of racial/ethnic disparities used archival data from patients' medical records, whereas our data included only medications that respondents reported using in the past month.…”

“…[12,13] Numerous investigations have found Black patients are less likely to be treated with analgesic medications, particularly opioid medications, compared to Whites. [14] Although racial differences in pain prevalence and treatment have been investigated, little attention has been paid to ethnic differences in chronic pain. This is striking, given that Hispanics represent one of the fastest growing demographic groups in the U.S. [15] Moreover, Hispanic Americans are at increased risk of experiencing pain due to occupational exposure [16] and have the lowest rates of health insurance of any racial/ethnic group.…”

Do Physicians Have an Ethical Duty to Repair Relationships with So-Called “Difficult” Patients?

“…Such biases may account for findings of racial and ethnic disparities in the assessment and management of pain [15]. For instance, studies have found racial disparities in the prescription of opioid painkillers in emergency departments [16,17].…”

Association between pain outcomes and race and opioid treatment: Retrospective cohort study of Veterans

“…Numerous studies have shown that blacks are less likely than whites to be prescribed opioid analgesics for a variety of pain conditions [1]. These disparities have been viewed as especially problematic in light of evidence that blacks experience chronic pain that is more severe and more disabling than whites [2][3][4][5][6][7].…”

“…These disparities have been viewed as especially problematic in light of evidence that blacks experience chronic pain that is more severe and more disabling than whites [2][3][4][5][6][7]. Although many factors contribute to these racial disparities in pain outcomes (e.g., racial differences in patients' beliefs about pain [4,[8][9][10], exposure to racial discrimination [11][12]), there is concern about the role of undertreatment of pain [1][2][3]13]. Consequently, recent position papers have highlighted the importance of reducing racial disparities in opioid prescription and proposed strategies to accomplish this goal [2][3].…”