The unequal burden of pain: confronting racial and ethnic disparities in pain.
BACKGROUND
Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites.


OBJECTIVE
To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided.


METHODS
A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication.


CONCLUSIONS
Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities.
Green
Carmen R
CR
Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA. carmeng@umich.edu
Anderson
Karen O
KO
Baker
Tamara A
TA
Campbell
Lisa C
LC
Decker
Sheila
S
Fillingim
Roger B
RB
Kalauokalani
Donna A
DA
Kaloukalani
Donna A
DA
Lasch
Kathyrn E
KE
Myers
Cynthia
C
Tait
Raymond C
RC
Todd
Knox H
KH
Vallerand
April H
AH
D001291:Attitude of Health Personnel / Q000208:ethnology; D003144:Communication Barriers; D003657:Decision Making; D003695:Delivery of Health Care / Q000639:trends; D006297:Health Services Accessibility / Q000639:trends; D006801:Humans; D008913:Minority Groups; D010146:Pain / Q000188:drug therapy / Q000208:ethnology*; D059408:Pain Management; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D014481:United States