Better Understanding of Racial, Ethnic Disparities in Pain Management Needed

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Hispanics are at higher risk for under treatment than non-Hispanic whites in EDs, academic primary care, and postoperative settings.
Hispanics are at higher risk for under treatment than non-Hispanic whites in EDs, academic primary care, and postoperative settings.

NATIONAL HARBOR, Md. — Few studies have examined how race and ethnicity effect the prevalence and experience of chronic pain in the United States, representing an urgent medical need to identify gaps in care and enhance pain management in underserved populations, according to a speaker at the American Academy of Pain Management 2015 meeting.

“Better understanding is needed about pain appraisal and the interpretation of pain in different racial/ethnic groups. This can influence how you as healthcare providers assess and manage pain, and engage patients and their families in shared decision making and treatment planning,” said Lara Dhingra, PhD, director of health disparities and outcomes research at the MJHS Institute for Innovation in Palliative Care.

Dr. Dhingra described the development and implementation of a novel electronic health record (EHR)-based decision support tool, called the Pain Management Support System for Primary Care (PMSS-PC), at the New York State Institute for Family Health (IFH), one of the largest federally-qualified community health center networks providing primary care to poor and medically underserved patients.

The PMSS-PC was designed to incorporated pain management best practices into the Epic EHR to help primary care providers at IFH better assess pain, screen for psychological and substance use problems, conduct opioid risk assessments, classify pain syndromes, and apply state-of-the art drug and non-drug therapies in practice. 

The Parent Study involved 6 IFH sites in Manhattan, the Bronx, and Mid-Hudson Valley, and included 522 patients undergoing treatment for chronic severe pain who indicated they were willing to return to the practice. Average patient age was 53 years, 70% were women, 77% were racial/ethnic minorities, 74% were unemployed, 76% had achieved high school education or less, and 63% had an annual income lower than $10,000.

The study aim was to assess chronic pain in the study sample and evaluate differences in the highly diverse racial and ethnic subgroups. Overall, Hispanics made up 42% of the population, followed by non-Hispanic blacks (27%), non-Hispanic whites (23%), and 8% who self-identified as “other.”

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