Racial differences in opioid use for chronic nonmalignant pain.
BACKGROUND
Chronic pain is a frequent cause of suffering and disability that negatively affects patients' quality of life. There is growing evidence that disparities in the treatment of pain occur because of differences in race.


OBJECTIVE
To determine whether race plays a role in treatment decisions involving patients with chronic nonmalignant pain in a primary care population.


METHODS
A cross-sectional survey was administered to patients with chronic nonmalignant pain and their treating physicians at 12 academic medical centers. We enrolled 463 patients with nonmalignant pain persisting for more than 3 consecutive months and the primary care physicians participating in their care.


RESULTS
Analysis of the 397 black and white patients showed that blacks had significantly higher pain scores (6.7 on a scale of 0 to 10, 95% confidence interval (CI) 6.4 to 7.0) compared with whites (5.6, 95% CI 5.3 to 5.9); however, white patients were more likely to be taking opioid analgesics compared with blacks (45.7% vs 32.2%, P<.006). Even after controlling for potentially confounding variables, white patients were significantly more likely (odds ratio (OR) 2.67, 95% CI 1.71 to 4.15) to be taking opioid analgesics than black patients. There were no differences by race in the use of other treatment modalities such as physical therapy and nonsteroidal anti-inflammatories or in the use of specialty referral.


CONCLUSIONS
Equal treatment by race occurs in nonopioid-related therapies, but white patients are more likely than black patients to be treated with opioids. Further studies are needed to better explain this racial difference and define its effect on patient outcomes.
Chen
Ian
I
Eastern Virginia Medical School, Norfolk, USA. chenia@evms.edu
Kurz
James
J
Pasanen
Mark
M
Faselis
Charles
C
Panda
Mukta
M
Staton
Lisa J
LJ
O'Rorke
Jane
J
Menon
Madhusudan
M
Genao
Inginia
I
Wood
JoAnn
J
Mechaber
Alex J
AJ
Rosenberg
Eric
E
Carey
Tim
T
Calleson
Diane
D
Cykert
Sam
S
D001741:Black or African American / Q000706:statistics & numerical data*; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000208:ethnology* / Q000534:rehabilitation; D010147:Pain Measurement; D010818:Practice Patterns, Physicians'; D044465:White People / Q000706:statistics & numerical data*
D000700:Analgesics; D000701:Analgesics, Opioid