Persistent Disparities in Pain Management for Minority Populations
In an update to the Journal of Pain Research’s formative meta-analysis on pain management in the US, researchers focused on the racial and ethnic disparities in access to pain treatment.
Persistent disparities exist in access to opioid analgesics in the US among Black and Hispanic populations, according to an updated meta-analysis published in the Journal of Pain Research.1 Researchers a part of the review believe collectively following evidence-based guidelines for pain treatment can improve access and efficacy of products.
“In recent years, the rate of overdose deaths from opioids—originally dubbed ‘Hillbilly heroin’ because of their almost exclusive misuse by white people—has grown significantly among Black people,” wrote Melba Newsome for KFF Health News.2 “This is largely due to the introduction of fentanyl, a synthetic opioid 50 to 100 times as powerful as morphine, which is often mixed into heroin and cocaine supplies and can be consumed unknowingly. In North Carolina, Black people died from an overdose at the rate of 38.5 per 100,000 residents in 2021—more than double the rate in 2019, according to North Carolina Department of Health and Human Services data.”
Despite 1 in 5 US citizens experiencing some form of chronic pain at some point in their lives, racial disparities in pain management persist. | image credit: NooPaew / stock.adobe.com
READ MORE: What Does the Future of Pain Medicine Look Like?
The complexities surrounding pain management in the US have seemingly outweighed most other areas of health care. Within a country that spends more on pain management than any other condition, the ongoing opioid crisis in many parts of the US is also a notably contributing factor to the complex issues of chronic and acute pain.
Despite 1 in 5 US citizens experiencing some form of chronic pain at some point in their lives,1 these issues have been known to be exacerbated among minority populations.
“Racial disparities in the context of pain management have been well established in medical literature,” according to authors of the Journal of Pain Research study. “Before patients even step foot in a hospital, myriad factors, including racial inequalities in distribution of health care resources, employment, income, and structural racism within the field of health care itself, inhibit equitable access to care for patients with minoritized racial and ethnic identities. Once patients have had access to, and sought, care for their pain, these inequities are exacerbated.”
The goal was to further understand, or update, researchers’ knowledge regarding racial disparities in pain management. Furthermore, they assessed the key moderators contributing to an association between race and pain outcomes. More specifically, researchers investigated the extent in which racial disparities exist despite a recent update to CDC prescribing guidelines.
In order to provide an updated review of the literature, researchers conducted guideline-directed search strategies that fully fleshed out the evidence presented in various journals and clinical studies on pain management from 2011 to 2021.
“In order to improve the quality and transparency of reporting, we followed MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines for our meta-analysis. These guidelines provide a standardized framework for reporting critical elements such as study design, population characteristics, exposure and outcome variables, and statistical methods. By employing these guidelines, we aimed to enhance the transparency and reproducibility of our analysis while minimizing the risk of bias,” they continued.1
With Meghani et al’s 2012 review of pain management as a basis, researchers’ current meta-analysis yielded significantly similar results. Despite there being a decade-long gap between the analyses, there is a persistent disparity in access to opioid analgesics for Black and Hispanic populations.
Also in line with previous reviews, Newsome further explained how Black populations continue to face increased barriers to opioid access when compared with White patients. These barriers include increased restrictions to access in urban locales, hyper-criminalization in Black neighborhoods, and more.2
“From a clinical practice perspective, this study shows that more efforts are needed to create an environment of equal and appropriate treatment in the field of pain management as well as patients’ access to effective non-opioid and non-pharmacological treatments,” continued authors of the study.1 “Accumulated evidence on sustained racial and ethnic differences in pain management, as well as unfounded misconceptions among clinicians about biological bases for differences in race and pain perception, warrants more comprehensive training in pain and pain care disparities of clinicians and practicing pain management specialists.”
Researchers concluded their study by looking to the future of access in pain management. Among policies and guidelines constantly changing in order to benefit population health, researchers believe future studies should focus on the impact these guidelines have on clinical barriers within pain management.
“In the future, studies may investigate the role of interval and widespread policy changes, such as the CDC opioid guidelines, for pain in addressing and ameliorating these clinical disparities,” they concluded.1
READ MORE: Pain Management Resource Center
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