The Journal of Law, Medicine & Ethics, Volume 28, Issue s4, Page 52-68, Mar 2001, doi: 10.1111/j.1748-720X.2001.tb00039.x
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Blackwell Synergy - Pain Medicine, Volume 4 Issue 3 Page 277-294, September 2003 (Article Abstract)
Pain Medicine
Volume 4 Issue 3 Page 277-294, September 2003
To cite this article: Carmen R. Green MD, Karen O. Anderson PhD, Tamara A. Baker PhD, Lisa C. Campbell PhD, Sheila Decker PhD, Roger B. Fillingim PhD, Donna A. Kaloukalani MD, MPH, Kathyrn E. Lasch PhD, Cynthia Myers PhD, Raymond C. Tait PhD, Knox H. Todd MD, MPH, April H. Vallerand PhD, RN (2003) The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain
Pain Medicine 4 (3) , 277–294 doi:10.1046/j.1526-4637.2003.03034.x
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Abstract
The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain
* Carmen R. Green, MDaaUniversity of Michigan Medical School, Ann Arbor, Michigan; ,
* Karen O. Anderson, PhDbbM.D. Anderson Cancer Center Pain Research Group, Houston, Texas; ,
* Tamara A. Baker, PhDccUniversity of Michigan, School of Public Health, Ann Arbor, Michigan; ,
* Lisa C. Campbell, PhDddDuke University Medical Center, Durham, North Carolina; ,
* Sheila Decker, PhDeeUniversity of Iowa School of Nursing, Iowa City, Iowa; ,
* Roger B. Fillingim, PhDffUniversity of Florida College of Dentistry, Gainesville, Florida; ,
* Donna A. Kaloukalani, MD, MPHggWashington University, St. Louis, Missouri; ,
* Kathyrn E. Lasch, PhDhhNew England Medical Center, Boston, Massachusetts; ,
* Cynthia Myers, PhDiiUniversity of California Los Angeles, Los Angeles, California; ,
* Raymond C. Tait, PhDjjSt. Louis University School of Medicine, St. Louis, Missouri; ,
* Knox H. Todd, MD, MPHkkEmory University, Rollins School of Public Health, Atlanta, Georgia; and , and
* April H. Vallerand, PhD, RNllWayne State University College of Nursing, Detroit, Michigan
*
aUniversity of Michigan Medical School, Ann Arbor, Michigan; bM.D. Anderson Cancer Center Pain Research Group, Houston, Texas; cUniversity of Michigan, School of Public Health, Ann Arbor, Michigan; dDuke University Medical Center, Durham, North Carolina; eUniversity of Iowa School of Nursing, Iowa City, Iowa; fUniversity of Florida College of Dentistry, Gainesville, Florida; gWashington University, St. Louis, Missouri; hNew England Medical Center, Boston, Massachusetts; iUniversity of California Los Angeles, Los Angeles, California; jSt. Louis University School of Medicine, St. Louis, Missouri; kEmory University, Rollins School of Public Health, Atlanta, Georgia; and lWayne State University College of Nursing, Detroit, Michigan
Carmen R. Green, MD, University of Michigan Medical School, Department of Anesthesiology, 1500 East Medical Center Drive, 1H247 UH—Box 0048, Ann Arbor, Michigan 48109. Tel: (734) 936-4240; Fax: (734) 936-9091; E-mail: carmeng@umich.edu.
ABSTRACT
context.
Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites.
objectives.
To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided.
evidence.
A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication.
conclusions.
Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities.
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