The Adequacy of Chronic Pain Management Prior to Presenting at a Tertiary Care Pain Center: The Role of Patient Socio-Demographic Characteristics

  • Carmen R. Green
    Address reprint requests to Carmen R. Green, MD, Professor, University of Michigan Health System, Department of Anesthesiology, 1H247 University Hospital, 1500 East Medical Center Drive SPC 5048, Ann Arbor, Michigan 48109-5048.
    Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan

    Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan

    Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
    Search for articles by this author
  • Tamera Hart-Johnson
    Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
    Search for articles by this author


      The Pain Management Index (PMI) is used to assess pain medication adequacy in black and white chronic pain patients (18–50 years) at referral to tertiary pain care. Using WHO guidelines for pain treatment, PMI was calculated from pain severity and drug analgesic potency. From 183 patients recruited, 128 provided treatment information for analyses (53% white, 60% female). Most (51.6%) had adequate PMI. Blacks were prescribed fewer pain medications (P = .03); fewer women had adequate medication strength (P = .04). In hierarchical regression, PMI was predicted at entry by female gender, lower MPI, higher affective MPQ, and a genderXage interaction. Younger men experienced better pain management, reducing toward the PMI level of women by age 50. In the final block, black race, being married, affective pain, and genderXage were associated with higher PMI, female gender and being employed were associated with lower PMI. Women, particularly younger women, were at higher risk for inadequate pain management in a primary care environment. These results support variability in chronic pain care and the need for research focusing on whether these disparities persist with specialized pain care.


      Most people with pain receive initial care in a primary care setting. This study examining the adequacy of pain management prior to specialty pain care showed blacks and women had less adequate pain care at referral. These results suggest the need for interventions and education in the primary care arena to improve pain care.

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