Impact of patient's race and socioeconomic status on chronic pain treatment recommendations

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Impact of patient's race and socioeconomic status on chronic pain treatment recommendations

Chronic pain could be any pain that lasts for more than 12 weeks. Differences in the treatment of pain have been noted for racial minorities. Socioeconomic status (SES) has been addressed in the setting of race, but rare experimental studies have examined its impact on pain treatment.

The researchers investigated the unique and interactive effects of patient race and SES on providers' recommendations for chronic pain treatment. Medical residents and fellows (N=207) studied 12 computer-simulated patients, differentiated by race (Black/White) and SES (low/high). They read text stories about the patient's occupation, pain etiology, self-reported pain intensity, and physical exam. Providers ranked the level of pain interference, which they believed, was experienced by patients and the probability they would prescribe opioids for pain relief. They use an opioid contract if opioids were prescribed, and suggest patients take time off work or explore workplace accommodations.

Repeated measure ANOVA was performed on ratings of pain interference, which symbolized the significant main effect of SES [F (1,206) = 91.23, p<.001] and a significant race-by-SES interaction [F (1,206) = 17.13, p<.001]. In case of high SES patients, the high rating for pain interference was given to Black than White patients. On the other hand, the rating was opposite for low SES patients. For opioid ratings significant main effects were found in SES but not in the race. It was estimated that providers were more likely to prescribe opioids [F (1,206) =10.35, p=.002] and use opioid contracts [F (1,206) =13.80, p<.001] for low SES patients. Also, significant main effect of SES [F (1,206) = 95.59, p<.001] and a significant race-by-SES interaction [F (1,206) = 11.80, p=.001] was discovered for work-related recommendations. For patients with low SES, providers were more inclined to recommend workplace accommodations for White than the Black patient. No race differences were noticed in case of high SES patients.

The investigators of the present study were successful in concluding that patients' race and SES have unique and interactive effects on the decisions of providers for pain treatment. The future research must include measurement of race and SES in detail to thoroughly understand the impact of these sociocultural variables on pain care.


The Journal of Pain

Link to the source:

The original title of the article:

Patient race and socioeconomic status influence providers’ recommendations about opioid therapy and workplace accommodations for chronic pain


T. Anastas, N. Hollingshead, et al.

Chronic pain, Recommendations, Race, Socioeconomic status
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