Do self-reported analgesic barriers translate into objective analgesic adherence for cancer pain?

Racial disparities in both prescription of analgesics for pain and their adherence by minority patients are widely documented. Interventions to improve analgesic adherence are based primarily on psychoeducational paradigm focusing on dismantling attitudinal barriers to cancer pain management. We investigated if self-reported analgesic barriers translate into objective adherence to analgesia for African Americans and Whites. African-Americans (n=102) and Whites (n=139) diagnosed with solid tumors having at least one prescription of around-the-clock analgesics were recruited from outpatient oncology clinics in the Mid-Atlantic region. Analgesic Adherence was captured using Medication-Event-Monitoring-System [MEMS®] over 3-months period (% of 'doses' taken compared with numbers prescribed). Analgesic Barriers were elicited using Barrier's Questionnaire (subscales: physiologic effects, fatalism, communication and harmful effects). African Americans reported significantly higher levels of cancer pain (p<.001), lower pain relief (p<.001), and greater pain-related functional-interference (p=.014). Despite significant pain, there were stark disparities between African Americans and Whites in analgesic adherence using MEMS® (55% vs. 74%, p=.000). Interestingly, while African Americans reported higher number of analgesic barriers when compared to Whites (p=.004), the relation of analgesic barriers to analgesic adherence was not straightforward. In separate multivariable regressions conducted with African Americans and Whites to identify unique predictors of adherence, none of the “self-reported analgesic barriers” accounted for analgesic adherence for Whites. For African Americans, only one barrier, i.e., tolerance fear, predicted actual analgesic adherence using MEMS; in adjusted analysis, the most powerful variables in predicting analgesic adherence were “intentional non-adherence” (i.e., stopping to use pain medications when feeling better or worse) and analgesic side-effects. These data suggests that our current understanding of the complex relations among barriers and adherence and if and how they contribute to pain outcomes are limited. Further, improving clinical management of pain may be central in ameliorating disparities in analgesic adherence for cancer pain. (Research support: NIHRC1NR011591).