Treatment Disparities Among the Black Population and Their Influence on the Equitable Management of Chronic Pain

Knoebel, Randall W; Starck, Janet V.; Miller, Pringl

doi:10.1089/heq.2020.0062

Cited by 25 publications

(17 citation statements)

References 41 publications

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“…It is important to note that because our examination of race and gender in the effects of pain on drinking was exploratory, with observed power values below recommended levels (e.g., 0.8; Serdar et al, 2021), these findings warrant replication and should be interpreted with caution. Nonetheless, given evidence of racial bias in pain assessment and treatment, and known disparities regarding the management of chronic pain among Black/African American populations (Hoffman et al, 2016; Knoebel et al, 2021), additional investigation into the role of pain in patterns and trajectories of alcohol consumption among Black drinkers is warranted.…”

Section: Discussionmentioning

confidence: 99%

Pain as a causal motivator of alcohol consumption: Associations with gender and race.

Ditre¹,

LaRowe²,

Powers³

et al. 2023

Journal of Psychopathology and Clinical Science

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Despite accumulating evidence indicating reciprocal interrelations between pain and alcohol consumption, no prior work has examined pain as a proximal antecedent of drinking. The goal of the current study was to test the effects of experimental pain induction on ad-lib alcohol consumption among moderate-to-heavy drinkers without chronic pain (N = 237; 42% female; 37% Black; M = 3.26daily drinks). Participants were randomized to either pain-induction (capsaicin + thermal heat paradigm) or no-pain-control conditions. Experimental pain induction lasted for 15 minutes, during which ad-lib alcohol consumption was assessed using an established taste test paradigm. As hypothesized, results indicated that participants randomized to the pain-induction condition poured and consumed more alcohol and reached a higher peak blood alcohol concentration than those randomized to the no-pain condition (ps < 0.05; ηp2 range = 0.018–0.021). Exploratory analyses revealed the effects of pain on alcohol consumption to be most pronounced among participants who self-identified as male or Black (relative to female or White, respectively). These findings indicate that the experience of pain serves as a causal, situational motivator for alcohol consumption, and suggest that current drinkers may be susceptible to escalating their consumption of alcohol in the context of pain. Future research is needed to explicate observed differences in the effects of pain on drinking as a function of gender and race, and to extend this work to individuals with chronic pain and varying levels of alcohol use. Collectively, these findings may help inform the development of integrated treatments to address co-occurring pain and alcohol use.

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Section: Discussionmentioning

confidence: 99%

Pain as a causal motivator of alcohol consumption: Associations with gender and race.

Ditre¹,

LaRowe²,

Powers³

et al. 2023

Journal of Psychopathology and Clinical Science

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…For example, the pain of Black Americans is often underdiagnosed and undertreated in the US, compared to that of their White counterparts. 37 , 38 The racial disparities may, in part, result from clinician factors. In experimental studies, participants showed more stringent thresholds for perceiving pain on Black faces, compared to White faces.…”

Section: Discussionmentioning

confidence: 99%

Pain Assessment in the Emergency Department: A Prospective Videotaped Study

Hsu

Cheng

et al. 2022

WestJEM

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Introduction: Research suggests that pain assessment involves a complex interaction between patients and clinicians. We sought to assess the agreement between pain scores reported by the patients themselves and the clinician’s perception of a patient’s pain in the emergency department (ED). In addition, we attempted to identify patient and physician factors that lead to greater discrepancies in pain assessment. Methods: We conducted a prospective observational study in the ED of a tertiary academic medical center. Using a standard protocol, trained research personnel prospectively enrolled adult patients who presented to the ED. The entire triage process was recorded, and triage data were collected. Pain scores were obtained from patients on a numeric rating scale of 0 to 10. Five physician raters provided their perception of pain ratings after reviewing videos. Results: A total of 279 patients were enrolled. The mean age was 53 years. There were 141 (50.5%) female patients. The median self-reported pain score was 4 (interquartile range 0-6). There was a moderately positive correlation between self-reported pain scores and physician ratings of pain (correlation coefficient, 0.46; P <0.001), with a weighted kappa coefficient of 0.39. Some discrepancies were noted: 102 (37%) patients were rated at a much lower pain score, whereas 52 (19%) patients were given a much higher pain score from physician review. The distributions of chief complaints were different between the two groups. Physician raters tended to provide lower pain scores to younger (P = 0.02) and less ill patients (P = 0.008). Additionally, attending-level physician raters were more likely to provide a higher pain score than resident-level raters (P <0.001). Conclusion: Patients’ self-reported pain scores correlate positively with the pain score provided by physicians, with only a moderate agreement between the two. Under- and over-estimations of pain in ED patients occur in different clinical scenarios. Pain assessment in the ED should consider both patient and physician factors.

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“…In a recent large national case–control study, African‐American/Black individuals were significantly less likely to receive outpatient rehabilitation than their white counterparts (odds ratio = 0.89) 88 . Specific to pain management, African‐American persons continue to experience disparities in the prevalence, management, progression, and outcomes of chronic, nonmalignant pain‐related conditions 89 …”

Section: Common Neurologic Sequelae and How To Best Guide Carementioning

confidence: 99%

“…88 Specific to pain management, African-American persons continue to experience disparities in the prevalence, management, progression, and outcomes of chronic, nonmalignant pain-related conditions. 89…”

Section: Initial Treatment Approachmentioning

confidence: 99%

Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

Melamed

Rydberg

Ambrose

et al. 2023

PM&R

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Treatment Disparities Among the Black Population and Their Influence on the Equitable Management of Chronic Pain

Cited by 25 publications

References 41 publications

Pain as a causal motivator of alcohol consumption: Associations with gender and race.

Pain as a causal motivator of alcohol consumption: Associations with gender and race.

Pain Assessment in the Emergency Department: A Prospective Videotaped Study

Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

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