In total, 75% of participants reported a previous chronic pain diagnosis, most commonly musculoskeletal in nature (50%). Patients were queried about pain treatments in the week prior to assessment — 43% reported using opioids, 57% reported non-opioids, and 26% reported non pharmacological strategies such as physical therapy, acupuncture or interventional pain management. “This represents a tremendous opportunity for practice change,” Dr. Dhingra said.
Among those who had reported using a prescribed analgesic in the previous 7 days, 45% had used a non steroidal antiinflammatory drug (NSAID), and 43% had used an opioid, followed by gabapentinoids (6%), muscle relaxers (4%), antidepressants (2%), and other (2%).
Non-pharmacological treatments reported included rehabilitative services (67%), integrative/mind-body (20%), interventional (11%), and psychotherapy (2%).
The study population had high levels of psychological comorbidities, with 38% reporting moderate-to-severe depressive symptomatology and 48% reporting moderate-to-sever anxious symptomatology on the NIH PROMIS. On health services utilization, 34% had reported visiting the emergency department for a pain-related problem and 16% reported being hospitalized due to pain n the previous 6 months.
When the researchers performed subgroup analyses, they identified several trends. Non-Hispanic white patients were more likely to use opioids and report higher pain interference then other race/ethnic groups.
Hispanics reported the lowest income, highest age, and poorest physical quality of life. They were also the most likely to use NSAIDs, and had the second highest rates of hospitalization and ED visits for pain.
“This extends findings from previous studies which indicated Hispanics are at higher risk for under treatment than non-Hispanic whites in EDs, academic primary care, and postoperative settings,” said Dr. Dhingra.
She called for additional studies of racial and ethnic difference in pain management among urban and low income populations. “Future research may reveal the social mechanisms that underlie these differences and aid in creating tailored interventions for pain in these populations.”
- Dhingra L, Baker T, Goodin B. “Pain and Disparities: Research Challenges, Potential Mechanisms, and Emerging Interventions.” Presented at: AAPM 2015. Sept. 17-20; National Harbor, Maryland.