New study reveals racial disparities in chronic pain management
Opioids are frequently prescribed for pain management in noncancer patients, but recommended clinical guidelines for monitoring effectiveness and signs of drug abuse are often not implemented. Alongside well-documented racial disparities in prescribing opioid medications for pain, researchers report racial differences in the use of recommended opioid monitoring and follow-up treatment practices. The study is published in the current issue of PAIN.
"In our study, we examined whether racial disparities exist in a more comprehensive set of opioid monitoring and treatment practices, including the use of an opioid agreement, the assessment of pain during follow-up visits, the use of urine drug screenings, and referrals to pain and substance abuse specialty clinics," says lead investigator Leslie R.M. Hausmann, PhD, Core Investigator, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and Assistant Professor of Medicine, University of Pittsburgh.
A retrospective cohort study examined racial differences in the documentation of pain and the involvement of specialists in the care of patients who are prescribed opioids for chronic noncancer pain. Investigators pulled data from electronic health records for 1646 white and 253 black patients who filled opioid prescriptions for noncancer pain for more than 90 days at the Veterans Affairs Pittsburgh Healthcare System pharmacy from October 2007 to September 2009. Additional data about opioid monitoring and follow-up treatment practices were pulled for a 12-month follow-up period, to complete a comprehensive profile.
Of these patients, nearly 94% were male, 22% were aged 65 or older, and 45% were married or lived with a partner. Patients were most often being treated for back pain or joint pain. About half of the study sample had at least one comorbid physical or mental health diagnosis, and one-third had a history of substance abuse.
Compared with white patients, black patients were significantly younger, less likely to be married, and less likely to have back pain. They had more physical comorbid conditions, more primary care appointments, and higher maximum pain scores. They were less likely to have a mental health diagnosis. Both study groups were equally likely to have a history of substance abuse. However, statistical analysis revealed significant racial differences in recommended opioid monitoring and follow-up treatment practices. Specifically, pain levels were less frequently documented for black patients than for white patients during medical visits. Among patients who had at least one urine drug test, black patients were also subjected to more tests, especially if they were on higher doses of opioids. Finally, black patients were less likely than white patients to be referred to a pain specialist and more likely to be referred for substance abuse assessment after being prescribed opioids.
"The emerging picture is that black patients who are able to overcome the barriers to securing a prescription for opioid medications may still be subjected to differential monitoring and follow-up treatment practices that could impact the effectiveness of their pain management," concludes Dr. Hausmann. "Addressing disparities in opioid monitoring practices may be a previously neglected route to reducing racial disparities in pain management."
Dr. Hausmann and colleagues suggest that "providing pain management support to primary care providers in the form of training on recommended guidelines and assistance with managing patients on long-term opioid regimens could improve overall adherence to recommended guidelines."
In an accompanying commentary, Megan Crowley-Matoka, PhD, of the Medical Humanities and Bioethics Program, Feinberg School of Medicine, Northwestern University, Chicago, says, "Pain management remains a persistent and pervasive problem across the practice of medicine. Despite strong consensus about the clinical, ethical, and economic importance of better managing pain, serious problems with both quality and equity continue to be routinely reported. The findings of Hausmann et al. suggest that, even for patients who overcome the barriers to receiving opioids, implementation of guideline recommendations is highly uneven and often racially disparate. Yet it is difficult to fully interpret what these data really tell us about the quality or equity of pain care, because we still know far too little regarding the efficacy of many of these practices, as well as what their appropriate level of use should be for most patients – much less how their differential use may affect black and white patients. Further complicating matters is the fact that so many of these practices associated with good pain care also run serious risk of being used by clinicians – and experienced by patients – in ways that are both punitive and prejudicial. These findings push us to move beyond this important first step of asking whether these practices are used, to examine more thoroughly and rigorously why and how they are used, and what outcomes are thus achieved."
More information: "Racial disparities in the monitoring of patients on chronic opioid therapy," by Leslie R.M. Hausmann, Shasha Gao, Edward S. Lee, C. Kent Kwoh (DOI: 10.1016/j.pain.2012.07.034).
"How to parse the protective, the punitive and the prejudicial in chronic opioid therapy?" by Megan Crowley-Matoka (DOI: 10.1016/j.pain.2012.10.013).
Journal reference: Pain
Provided by Elsevier
- Black patients more likely to be monitored for prescription drug abuse May 10, 2011 | not rated yet | 0
- Use of opioids for pain in ERs on the rise, but racial differences in use still exist Jan 02, 2008 | not rated yet | 0
- Opioid prescription is on the increase Feb 12, 2013 | not rated yet | 0
- Blacks, Hispanics less likely to get strong pain drugs in emergency rooms Jan 02, 2008 | not rated yet | 0
- Researchers find anti-depressants reduce pain in opioid-dependent patients Nov 03, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
How can there be a term called "intestinal metaplasia" of stomach
23 hours ago Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013 As an experiment, for the past few months I've been consuming at least one portion of Jell-O or unflavored Knox gelatin per day. I'm 64, in very...
Alcohol and acetaminophen
May 13, 2013 Edit: sorry for the typo in the title , can't edit I looked around on google quite a bit and it's very hard to find precise information on the...
- More from Physics Forums - Medical Sciences
More news stories
An experimental sleeping pill from US drug company Merck is effective at helping people fall and stay asleep, according to reviewers at the US Food and Drug Administration, which could soon approve the new drug.
Medications 12 hours ago | 4 / 5 (4) | 0
Transparent information on the evidence supporting global recommendations on paediatric medicines should be easily accessible in order to help policy makers decides on what drugs to include in their national drug lists, according ...
Medications 12 hours ago | not rated yet | 0
Regardless of pain, social class or age, a woman is more likely to be prescribed pain-relieving drugs. A study published in Gaceta Sanitaria (Spanish health scientific journal) affirms that this phenomenon is inf ...
Medications 20 hours ago | not rated yet | 0
A new report suggests that improved health care and significant reductions in drug costs might be attained by breaking up the age-old relationship between physicians and drug company representatives who promote the newest, ...
Medications May 20, 2013 | 5 / 5 (1) | 0
Is it permissible to harm one to save many? Those who tend to say "yes" when faced with this classic dilemma are likely to be deficient in a specific kind of empathy, according to a report published in the scientific journal ...
54 minutes ago | not rated yet | 0 |
Phthalates: Study links chemicals widely found in plastics, processed food to elevated blood pressure in children, teens
Plastic additives known as phthalates (pronounced THAL-ates) are odorless, colorless and just about everywhere: They turn up in flooring, plastic cups, beach balls, plastic wrap, intravenous tubing and—according to the ...
1 hour ago | not rated yet | 1 |
(Medical Xpress)—Native peoples in regions where cameras are uncommon sometimes react with caution when their picture is taken. The fear that something must have been stolen from them to create the photo ...
18 hours ago | 4.2 / 5 (5) | 0 |
(Medical Xpress)—Despite spending billions of dollars on research and development, drug companies have been unable to come up with effective treatments for dementia and Alzheimer's Disease (AD). Now, A. ...
16 hours ago | 4.9 / 5 (14) | 0 |
Australian scientists have charted the path of insulin action in cells in precise detail like never before. This provides a comprehensive blueprint for understanding what goes wrong in diabetes.
18 hours ago | 4.6 / 5 (7) | 0 |
Activating an enzyme known to play a role in the anti-aging benefits of calorie restriction delays the loss of brain cells and preserves cognitive function in mice, according to a study published in the May ...
12 hours ago | 5 / 5 (5) | 0 |