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Cited by 1,248Cultural Competency in Health CarePain Management and Opioid UsePediatric Pain Management Techniques

The unequal burden of pain: confronting racial and ethnic disparities in pain

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Green, Carmen R., Anderson, Karen O., Baker, Tamara A., Campbell, Lisa C., Decker, Sheila, Fillingim, Roger B., Kaloukalani, Donna A., Lasch, Kathyrn E. +4 more·2003·Pain Medicine
DOI 10.1046/j.1526-4637.2003.03034.x
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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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  • A primarily biomedical approach does not address the wholeness of the person experiencing chronic pain or their layered challenges, including socioeconomic and structural inequities and inadvertent consequences of opioid analgesics.

    “A primarily biomedical approach does not address the wholeness of the person experiencing chronic pain, nor their layered challenges including socioeconomic and structural inequities and inadvertent consequences of opioid analgesics which may have been prescribed for lack of better options.12-16”

    From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [13]

    The Experimental Pain section describes pain through a biopsychosocial model, and the Health Care Systems Factors section discusses socioeconomic influences and racial disparities in access to pain care. These passages support the need to consider more than biological factors. They do not address unintended consequences of prescribed opioids or say that opioids were prescribed for lack of better options; the paper instead discusses disparities in opioid availability. (LLM, conf=0.88)

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  • Anema and colleagues compared sustainable return-to-work rates across six countries and found job characteristics and social disability systems more important than medical, patient, and injury factors in explaining between-country differences after painful occupational injuries.

    “Anema and colleagues 134 compared sustainable return-to-work rates between 6 different countries and found that differences in job characteristics and social disability systems were more important than medical interventions, patient, and injury-related factors in explaining the large between-country differences in rates of return to work following painful occupational injuries.”

    From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [134]

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Cites

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Research works printed but not linked: 12

  1. Lasch K. Culture and pain. Pain Clin Update 2002;10:5.
  2. Agency for Health Care Policy and Research. Acute pain management: Operative or medical procedures and trauma, part 2. Clin Pharm 1992;11:391-414.
  3. Todd KH, Deaton C, D'Adamo AP, Goe L. Eth- nicity and analgesic practice. Ann Emerg Med 2000;35:11-6.
  4. Vallerand A, Riley-Doucet C, Hasenau S, Templin T. Disparities in cancer-related pain in the outpa- tient clinic population. Pain 2003;4:2(suppl 1):2.
  5. Anderson KO, Mendoza TR, Valero V, Richman SP, Russell C, Hurley J, DeLeon C, Washington P, Palos G, Payne R, Cleeland CS. Minority cancer patients and their providers: Pain management attitudes and practice. Cancer 2000;88:1929-38.
  6. Herr KA, Mobily PR. Chronic pain and depres- sion. J Psychosoc Nurs Ment Health Serv 1992;30:7-12.
  7. Edwards CL, Fillingim RB, Keefe F. Race, ethnic- ity and pain: A review. Pain 2001;94:133-7.
  8. Green CR, Baker T, Washington T. Health care attitudes and utilization in chronic pain patients: A comparison of African and Caucasian Americans. Pain 2003;4:2(suppl 1):97.
  9. Welch LS, Hunting KL, Nessel-Stephens L. Chronic symptoms in construction workers treated for musculoskeletal injuries. Am J Ind Med 1999; 36:532-40. 110
  10. Chibnall JT, Tait RC, Merys SC. Disability man- agement of low back injuries by employer-retained physicians: Ratings and costs. Am J Ind Med 2000; 38:529-38. 112
  11. Helme R, Gibson S. Pain in older people. In: Crombie IK, editor. Epidemiology of pain. Seattle: IASP Press; 1999. p. 103-12. 127
  12. Juarez G, Ferrell B, Borneman T. Cultural con- siderations in education for cancer pain manage- ment. J Cancer Educ 1999;14:168-73. 160

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Authors
Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R. B., Kaloukalani, D. A., Lasch, K. E., Myers, C., Tait, R. C., Todd, K. H., & Vallerand, A. H.
Affiliations
  • University of Michigan (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • Duke Medical Center (US)
  • University of Iowa (US)
  • University of Florida (US)
  • Washington University in St. Louis (US)
  • Tufts Medical Center (US)
  • Emory University (US)
  • University of California, Los Angeles (US)
  • Wayne State University (US)
ORCID
Venue
Pain Medicine
Publisher
Oxford University Press (OUP)
Published
2003-09
Volume
4
Issue
3
Pages
277-294
ISSN
  • 1526-2375 (ISSN-L)
  • 1526-4637
DOI
10.1046/j.1526-4637.2003.03034.x
OpenAlex
W2049609735
Cited by
1,248
References
188
Citations by year
2026: 33 · 2025: 75 · 2024: 84 · 2023: 84 · 2022: 77 · 2021: 97 · 2020: 70 · 2019: 61 · 2018: 58 · 2017: 46 · 2016: 68 · 2015: 48 · 2014: 48 · 2013: 43 · 2012: 50
FWCI
16.26
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1 (tdm, 4383 d)
Locations
  • Pain Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
  • University Libraries (University of Maryland) (submittedVersion)
  • Digital Repository at the University of Maryland (University of Maryland College Park)
Funders
American Pain Society
Topics
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords
racial and ethnic disparities, pain management, undertreatment of pain, racial minorities, pain perception, pain assessment, postoperative pain, cancer pain, chronic non-cancer pain, experimental pain, emergency department, access to pain medication, patient-provider communication, health system factors, health disparities
MeSH terms
Attitude of Health Personnel, Communication Barriers, Decision Making, Delivery of Health Care, Health Services Accessibility, Humans, Minority Groups, Pain, Quality of Health Care, Socioeconomic Factors, United States, Pain Management

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