Nurse researchers find disparities in pain treatment

Pain is generally undertreated in the United States, but low-income and minority patients are even less likely to receive guideline-recommended pain treatment in virtually all healthcare settings, according to the authors of a new paper from the University of Pennsylvania School of Nursing.

That fact holds true even though minority patients often suffer more severe pain and physical impairments than non-minority patients and are more likely to perform potentially harmful physical work, the authors said.

In a report appearing in Pain Medicine, the official journal of the American Academy of Pain Medicine, the reviewers recommended:

• Creating public education programs not only for chronic pain, but for educating the public about disparities.

• Instituting public health marketing campaigns for pain disparities.

• Urging pain advocacy groups to unite on issues of common interest, such as disparities in pain care.

• Setting quality assurance standards for pain treatment through the Centers of Medicare and Medicaid Services or the National Quality Forum,

• Including measures of disparities as part of the Pain and Policy Studies Group statewide pain report cards.

Poor and minority patients often experience pain for many years before being seen by a specialist in pain treatment, possibly because health providers are more likely to underassess pain in minorities, the reviewers said. Minority and low-income patients also are more likely to live in geographic areas that restrict their access to healthcare, while pharmacies in minority zip codes are significantly less likely to have sufficient supplies of pain medications than pharmacies in predominantly white zip codes.

“There is no question that pain treatment disparities matter in many significant ways,” Penn Nursing professor and lead study author Salimah Meghani, RN, PhD, said in a news release. “The most important are the tremendous burdens placed on patients, health systems and society when the most effective pain care is not accessible, affordable and delivered to those in need.

“Until the prevailing issues of inequitable healthcare are realized and confronted through focused and systematic strategies for education, research and healthcare reform, it is unlikely that progress will occur in reducing and ultimately eliminating pain disparities.”

According to recent estimates, chronic pain affects 116 million American adults and remains the most common reason people seek medical care. The burden of pain on Americans in direct and indirect costs can reach $635 billion annually. This expenditure includes disability, poor quality of life, relational problems, lost income and productivity, and higher healthcare utilization including longer hospital stays, ED visits and unplanned clinic visits.

Meghani and colleagues, including Penn Nursing professor Rosemary Polomano, RN, PhD, FAAN, also proposed broad advocacy initiatives such as “Look at the Data Campaigns,” especially targeted at providers to sensitize them to their blind spots that contribute to inequitable pain care — emphasizing the need for targeted education in pain disparities as part of graduate and continuing medical education, and in licensure, accreditation and certification programs for medicine, nursing and allied health professionals.

Although the Patient Protection and Affordable Care Act mandates federally funded programs to consistently collect data to track trends in healthcare disparities, the authors urged the creation of public-private partnerships in promoting standardized reporting of race and ethnicity data to allow researchers to track disparities, monitor efforts to reduce them and compare findings across studies regardless of the source of funding.

To read a study summary and access the study via subscription or purchase, visit

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