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Minorities Are Under Treated and Under Medicated for Pain
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Posted on: 12/31/2009
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Non-white racial groups suffer from more than just a lack of housing, employment, and justice in the criminal system. They also receive unequal health care. In this review, researchers take a look at one specific area of health care inequalities among minority groups: pain. Whether it's acute pain, chronic pain, cancer pain, arthritis pain, or pain after surgery, it is suspected that all people are not treated alike when it comes to pain management.
The U.S. Department of Health and Human Services set up a group of goals to improve the health of all Americans by 2010. As 2009 comes to a close and the year 2010 is upon us, how well are we doing in this area of pain assessment, treatment, and outcomes for ALL Americans? How far along are we in meeting the goal or reducing and even getting rid of any differences in the treatment of minorities who are suffering from painful conditions? Minorities include African Americans (blacks), Hispanics, Asians, Alaskan Natives, and native Hawaiians or other Pacific islanders.
What do these inequalities look like in a clinical sense? Take for example, care in the emergency room. It is often the case that Hispanic and African American patients are not given any pain medication for broken bones. This is true for Hispanics even when English is their main language and they have adequate health insurance. When it comes to the treatment of disabling pain from headaches or back problems, minorities are less likely to be given opioid (narcotic) medications. Only children (under age 18) are more likely to be treated adequately. But there have been some reports of withholding treatment in the emergency department (and other health care settings) for minority children.
Studies assessing control of postoperative pain report varied results. There may be a trend for better postop pain control in a descending order: Caucasians are offered the highest dose of opioids, then blacks, Hispanics, and Asian Americans last with the lowest dose for the same level of pain. And there's been some data to show that this is true even when other factors are equal such as insurance coverage, type of surgical procedure, and number of days in the hospital.
Cancer is a big topic in the news these days. With known statistics that one out of every two men and one of every three women will develop cancer sometime in their lifespan, cancer is becoming an important focus of health care. Minorities are less likely to receive screening or preventive care, so the diagnosis is made later. A delayed diagnosis often means more advanced disease and more painful symptoms. And despite increasing awareness of unequal screening and treatment, this trend has not changed in the last 20 years.
The statistics aren't much different for minorities with chronic noncancer pain from arthritis, headaches, fibromyalgia, multiple sclerosis, or other chronic condition. Health care providers underestimate pain levels for minorities with chronic diseases. Minority women are less likely to have a complete medical workup or have surgery offered as a treatment option compared with all other groups including men of the same ethnic or racial background.
Under treatment of pain from any cause is compounded by the fact that studies show minorities start with a poorer quality of health and lower quality of life. These two factors may contribute to greater perception of pain and/or higher levels of pain compared with Caucasians who have the same underlying condition.
The authors conclude after reviewing studies over the last 10 years and comparing them to previous studies that there are continued inequities in the way minorities are treated for pain. Minorities are less likely to receive specialty care and more likely to experience delays in diagnosis and treatment. They start out with a lower quality of life and poorer function due to health problems. Pain added on top of those conditions further diminishes their health status.
What can be done about this? Clearly, we don't need more studies to show there are inequities. There is plenty of proof that the problem exists. But there may be a variety of factors affecting how minorities present themselves and are perceived and treated. On the flip side of the coin, there may be important factors among health care providers affecting how they view patients differently based on age, gender, and ethnicity. Health care providers have their own beliefs and expectations. And the health care system as it is set up today with lack of insurance or under insurance limiting resources available to patients is a barrier to pain management all of its own.
Sometimes there are language barriers that make it more difficult to assess patient pain levels. In other cases, there are differing patient beliefs, cultural beliefs, attitudes, and coping strategies that affect how patients are evaluated and treated. Researchers are starting to take a closer look at these kinds of factors. They are also investigating genetic factors, differences in pain sensitivity among minorities, and even how different ethnic groups respond differently to pain medications at a biologic level.
Back to the question of what can be done to reduce these kinds of inequities. The authors identify three ways to approach this problem: through the patient, the provider, and the health care system. Educating health care providers may be one approach. If providers can be taught to assess and treat everyone the same, outcomes may improve. Evidence-based treatment guidelines for pain associated with different causes are needed to help providers give the care that patients need.
Availability and affordability of prescribed medications must be addressed through health care reform. Money is needed to fund pain research with a goal of providing practical health care policies around the treatment of pain. Public health must include a focus on the well-documented causes and results of racial and ethnic disparities in the treatment (or lack of treatment) of pain.
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References:
Karen O. Anderson, et al. Racial and Ethnic Disparities in Pain: Causes and Consequences of Unequal Care. In The Journal of Pain. December 2009. Vol. 10. No. 12. Pp. 1187-1204.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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