Abstract
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.
Perspective
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.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Why is pain more common amongst people living in areas of low socio-economic status? A population-based cross-sectional study.Br Dent J. 2003; 194: 383-387
- Chronic pain in a geographically defined general population: Studies of differences in age, gender, social class, and pain localization.Clin J Pain. 1993; 9: 174-182
- Cognitive impairment and depression predict mortality in medically ill older adults.J Gerontol A Biol Sci. 1999; 54A: M152-M156
- Ethnocultural influences on variation in chronic pain perception.Pain. 1993; 52: 101-112
- The new JCAHO pain standards: Implications for pain management nurses.Pain Manage Nurs. 2000; 1: 3-12
- Race, ethnicity, and pain treatment: Striving to understand the causes and solutions to the disparities in pain treatment.J Law Med Ethics. 2001; 29: 52-68
- National Institutes of Health grant awards for pain, nausea, and dyspnea research: An assessment of funding patterns in 2003.J Pain. 2005; 6: 275-276
- Factors influencing physician management of cancer pain.Cancer. 1986; 58: 796-800
- Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group minority outpatient pain study.Ann Intern Med. 1997; 127: 813-816
- Pain and its treatment in outpatients with metastatic cancer.N Engl J Med. 1994; 330: 592-596
- Ethnic differences in pain tolerance: Clinical implications in a chronic pain population.Psychosom Med. 2001; 63: 316-323
- Sex, gender, and pain: Women and men really are different.Curr Rev Pain. 2000; 4: 24-30
- Pain and pain treatment in aids patients: A longitudinal study.J Pain Symptom Manage. 2000; 19: 339-347
- The association among neighborhood socioeconmic status, race and chronic pain in black and white older adults.J Natl Med Assoc. 2007; 99: 1160-1169
- Reliability and validity of a visual analog scale for acute abdominal pain in the ED.Am J Emerg Med. 2002; 20: 287-290
- Physician variability in pain management: Are the JCAHO standards enough?.Pain Med. 2003; 4: 1-3
- Adequacy assessment of oxycodone/paracetamol (acetaminophen) in multimodal chronic pain: A prospective observational study.Clin Drug Investig. 2009; 29: 31-40
- Cognitive factors and the experience of pain and suffering in older persons.Pain. 2000; 85: 375-383
- Pain in older persons.Disabil Rehabil. 1994; 16: 127-139
- Unequal burdens and unheard voices: Whose pain? Whose narratives?.in: Carr D.B. Loeser J.D. Morris D.B. Narrative, Pain, and Suffering, Progress in Pain Research and Management, Vol. 34. IASP Press, Seattle, WA2005 (pp 195-214)
- The unequal burden of pain: Confronting racial and ethnic disparities in pain.Pain Med. 2003; 4: 277-294
- Patient attitudes regarding healthcare utilization and referral: A descriptive comparison in African- and Caucasian Americans with chronic pain.J Natl Med Assoc. 2004; 96: 31-42
- Race and chronic pain: A comparative study of young black and white Americans presenting for management.J Pain. 2003; 4: 176-183
- The effect of race in older adults presenting for chronic pain management: A comparative study of black and white Americans.J Pain. 2003; 4: 82-90
- Disparities in chronic pain management upon initial assessment to a tertiary care pain center.J Pain. 2005; 6: S42
- Race, age, and gender influences among clusters of African American and white patients with chronic pain.J Pain. 2004; 5: 171-182
- Differences in prescription opioid analgesic availability: Comparing minority and white pharmacies across Michigan.J Pain. 2005; 6: 689-699
- Introduction: The unequal burden of pain: Disparities and differences.Pain Med. 2005; 6: 1-2
- Physician variability in the management of acute postoperative and cancer pain: A quantitative analysis of the Michigan experience.Pain Med. 2003; 4: 8-20
- Clinical decision making in pain management: Contributions of physician and patient characteristics to variations in practice.J Pain. 2003; 4: 29-39
- How well is chronic pain managed? Who does it well?.Pain Med. 2002; 3: 56-65
- Analysis of the physician variable in pain management.Pain Med. 2001; 2: 317-327
- Goal to Eliminate Health Care Disparities: Guidance for the National Healthcare Disparities Report.National Academies Press, Washington, DC2002
- John Henryism and blood pressure differences among black men. II. The role of occupational stressors.J Behav Med. 1984; 7: 259-275
- New standards: A pain in the assessment.Briefings on JCAHO. 1999; (pp 6-7)
- Standards, intents, examples, and scoring questions for pain assessment and management - comprehensive accreditation manual for hospitals, in: JCAHO Department of Standards. 1999; (pp 1-11)
- The black/white disability gap: Persistent inequality in later life?.J Gerontol B Psychol Sci Soc Sci. 2004; 59: S34-43
- The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).Pain. 1985; 23: 345-356
- The role of clinical uncertainty in treatment decisions for diabetic patients with uncontrolled blood pressure.Ann Intern Med. 2008; 148: 717-727
- A comparison of blacks and whites seeking treatment for chronic pain.Clin J Pain. 2001; 17: 249-255
- The hidden error of mismanaged pain: A systems approach.J Pain Symptom Manage. 2004; 28: 47-58
- The McGill Pain Questionnaire: Major properties and scoring methods.Pain. 1975; 1: 277-299
- Race or class versus race and class: Mortality differentials in the United States.Lancet. 1990; 336: 1238-1240
- JCAHO pain management standards are unveiled. Joint Commission on Accreditation of Healthcare Organizations.JAMA. 2000; 284: 428-429
- An assessment of methods used to evaluate the adequacy of cancer pain management.J Pain Symptom Manage. 2006; 32: 581-588
- Racial disparities in the quality of care for enrollees in Medicare managed care.JAMA. 2002; 287: 1288-1294
- The effect of race and sex on physicians' recommendations for cardiac catheterization.N Engl J Med. 1999; 340: 618-626
- Empirical evidence of the association between the presence of musculoskeletal pain and physical disability in community-dwelling senior citizens.Pain. 1998; 75: 229-235
- Correlates of Beck Depression Inventory scores in an ambulatory elderly population: Symptoms, diseases, laboratory values, and medications.J Fam Pract. 1991; 32: 497-502
- Racial/ethnic disparities in breast and gynecologic cancer treatment and outcomes.Curr Opin Obstet Gynecol. 2007; 19: 31-36
- Patient-related barriers to management of cancer pain.Pain. 1993; 52: 319-324
- SF-36 Health Survey: Manual and Interpretation Guide, (2nd ed.).QualityMetric Incorporated, Lincoln, RI2000
- Gender differences in psychosocial adjustment to chronic pain and expenditures for health care services used.Clin J Pain. 1996; 12: 277-290
Article info
Publication history
Published online: April 19, 2010
Accepted:
November 11,
2009
Received in revised form:
October 8,
2009
Received:
January 19,
2009
Footnotes
Supported by the Aetna Quality Care Fund.
Identification
Copyright
© 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.
