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Cited by 125Pain Management and Opioid UseCultural Competency in Health CareOpioid Use Disorder Treatment

Advancing a National Agenda to Eliminate Disparities in Pain Care: Directions for Health Policy, Education, Practice, and Research

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Meghani, Salimah H., Polomano, Rosemary C., Tait, Raymond C., Vallerand, April H., Anderson, Karen O., Gallagher, Rollin M.·2012·Pain Medicine
DOI 10.1111/j.1526-4637.2011.01289.x
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Abstract

BACKGROUND: Pain is strongly associated with significant personal and societal costs. A crucial element of any initiative on pain must focus on eliminating pain care disparities that are pervasive throughout the United States health care settings. OBJECTIVES: This report focuses on macro-level factors related to pain care disparities in the United States that may be amenable to policy interventions. METHODS: We identify concrete opportunities for achieving equity in pain care, especially those occasioned by recent legislative changes in the United States health care system. An aggressive policy, advocacy, and research agenda is synthesized in five domains: 1) structural/system; 2) policy and advocacy; 3) workforce; 4) provider; and 5) research. RESULTS: Inequities in pain care remain an important and neglected health policy concern. Many direct and indirect provisions within the Affordable Care Act (ACA) and other national initiatives that leverage on ACA offer opportunities to achieve equity in pain care. These include changes in insurance, in public, provider, and legislative education, in primary care and pain specialist training, improving workforce diversity, achieving uniformity in race/ethnicity data collection, emphasizing patient-centered outcomes research, and encouraging focus on pain care disparities within the comparative effectiveness research paradigm. CONCLUSIONS: Recent national legislative initiatives within ACA are expected to generate multilevel efforts that will impact the flow of funding to address the pervasive issue of disparities. It is an opportune time for the pain community to take a lead in implementing a concerted agenda on pain care disparities in order to leverage these national initiatives.

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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 [16]

    Section B4 (page not specified in our copy) advocates biopsychosocial, integrated pain care that addresses psychological and social factors rather than relying on medication alone. Section B1 discusses socioeconomic barriers, inequitable pain treatment, and unintentional overdoses of prescription pain medication. The paper does not say that opioids were prescribed for lack of better options. (LLM, conf=0.84)

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  1. Smedley BD, Stith AY, Nelson AR. Institute of Medi- cine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2003.
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  5. American Medical Association. Total Physicians by Race/Ethnicity-2008. 2008. Available at: http:// www.ama-assn.org/ama/pub/about-ama/our- people/member-groups-sections/minority-affairs- consortium/physician-statistics.page (accessed June 2011).
  6. Tait RC, Chibnall JT, Kalauokalani D. Provider judg- ments of patients in pain: Seeking symptom cer- tainty. Pain Med 2009;10(1):11-34. 138
  7. Fiske ST, Taylor SE. Social Cognition, 2nd edition. New York: McGraw-Hill, Inc.; 1991. 140
  8. U.S. Census Bureau. Census 2000 Brief: Overview of Race and Hispanic Origin. 2001. Available at: http://www.census.gov/prod/2001pubs/c2kbr01- 1.pdf (accessed April 2011). 148 Khorana AA. Concordance: How does a physician who is neither black nor white decide when race is a factor? Health Aff (Millwood) 2005;24(2):511-5. 149 National Institutes of Health. NOT-OD-01-053: NIH policy on reporting race and ethnicity data. 2001. Available at: http://grants.nih.gov/grants/guide/ notice-files/not-od-01-053.html (accessed June 2011). 150 National Institutes of Health. PROMIS. 2011 Available at: http://www.nihpromis.org (accessed June 2011). 151

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Authors
Meghani, S. H., Polomano, R. C., Tait, R. C., Vallerand, A. H., Anderson, K. O., & Gallagher, R. M.
Affiliations
  • University of Pennsylvania (US)
  • Saint Louis University (US)
  • Wayne State University (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • Philadelphia VA Medical Center (US)
Corresponding author
Meghani, Salimah H.
ORCID
Venue
Pain Medicine
Publisher
Oxford University Press (OUP)
Published
2012-01
Volume
13
Issue
1
Pages
5-28
ISSN
  • 1526-2375 (ISSN-L)
  • 1526-4637
DOI
10.1111/j.1526-4637.2011.01289.x
OpenAlex
W1946691868
Cited by
124
References
130
Citations by year
2026: 2 · 2025: 4 · 2024: 10 · 2023: 14 · 2022: 13 · 2021: 13 · 2020: 6 · 2019: 8 · 2018: 7 · 2017: 7 · 2016: 9 · 2015: 6 · 2014: 16 · 2013: 6 · 2012: 3
FWCI
10.90
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1 (tdm, 1339 d)
Locations
  • Pain Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • University Libraries (University of Maryland) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Digital Repository at the University of Maryland (University of Maryland College Park)
Funders
Janssen Scientific Affairs
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
health equity, Affordable Care Act, health policy, pain education, patient-centered outcomes research, comparative effectiveness research, health insurance coverage, health care legislation
MeSH terms
Education, Medical, Continuing, Education, Medical, Graduate, Ethnicity, Health Planning Guidelines, Health Policy, Humans, United States, Biomedical Research, Healthcare Disparities, Pain Management

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