Race/Ethnicity May Not Accurately Predict Health-Related Quality of Life in Chronic Pain

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“Factors that covary with race/ethnicity may be the primary drivers of pain-related adjustment," concluded the authors.
“Factors that covary with race/ethnicity may be the primary drivers of pain-related adjustment," concluded the authors.

Age, anxiety, and socioeconomic status are better predictors than race and ethnicity for health-related quality of life (HRQL) outcomes in patients with chronic pain, according to a study published in Pain Medicine.

This secondary analysis included patients with chronic pain who participated in a previously studied electronic health record-based strategy for pain management (n=522). The investigators compared participants classified as non-Hispanic blacks (n=142), non-Hispanic whites (n=121), Hispanics (n=219), and “other” (n=40) to evaluate the association between race/ethnicity and HRQL in chronic pain.

Average worst pain, as reported on the Brief Pain Inventory-Short Form (BPI-SF), was 8.6 on a 0 to 10 scale. Overall, the scores for HRQL in this sample were worse than scores reported in the general population (physical: standardized T-score [T], 35.0; standard deviation [SD], 6.2; mental: T, 37.5; SD, 7.8; P <.001 for all).

According to a multivariate analysis, annual income (β coefficient, 2.775; P =.002), anxiety symptoms (β, -0.132; P <.001), pain interference (β, -0.150; P <.001), physical HRQL (β, 0.288; P <.001), and depressive symptoms (β, -0.237; P <.001) accounted for 46.5% of the variance in mental HRQL.

Posthoc analyses and analyses of variance found no significant association between race and mental HRQL (P =.125). In low-income non-Hispanic black participants, there was no significant association between race and mental HRQL (P =.719) or physical HRQL (P =.161). Similarly, no associations were found between Hispanic race and mental HRQL (P =.747) or physical HRQL (P <.001).

Additionally, physical HRQL was associated with age (P =.012) in low-income patients, and mental and physical HRQL were associated with pain interference (P <.001 for both) and anxiety (P <.001 for both) in this population.

In this analysis, the researchers did not account for specific psychosocial and medical factors (eg, baseline comorbidities, patients' pain beliefs, social support) that may have influenced HRQL. In addition, because women comprised the majority of the cohort (70.1%), these findings may be difficult to generalize across the male patient population.

The finding that race/ethnicity are not reliable predictors for physical and mental HRQL “raises important questions about the extent to which factors that covary with race/ethnicity may be the primary drivers of pain-related adjustment,” concluded the investigators.

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Reference

Dhingra L, Schiller R, Teets R, et al. Race and ethnicity do not clinically associate with quality of life among patients with chronic severe pain in a federally qualified health center [published online May 10, 2017]. Pain Med. doi: 10.1093/pm/pnx040

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