title: When race matters: disagreement in pain perception between patients and their physicians in primary care.
abstract: Patients and physicians often disagree in their assessment of pain intensity. This study explores the impact of patient factors on underestimation of pain intensity in chronic noncancer pain. We surveyed patients and their physicians in 12 primary care centers. To measure pain intensity, patients completed an 11-point numeric rating scale for which pain scores range from 0 (no pain) to 10 (unbearable pain). Physicians rated patients' pain on the same scale. We defined disagreement of pain intensity as underestimation or overestimation by 22 points. Of 601 patients approached, 463 (77%) completed the survey. The majority of participants were black (39%) or white (47%), 67% were female, and the mean age was 53 years. Physicians underestimated pain intensity relative to their patients 39% of the time. Forty-six percent agreed with their patients' pain perception, and 15% of physicians overestimated their patients' pain levels by > or =2 points. In both the bivariate and multivariable models, black race was a significant variable associated with underestimation of pain by physicians (p < 0.05; OR = 1.92; 95% CI: 1.31-2.81). This study finds that physicians are twice as likely to underestimate pain in blacks patients compared to all other ethnicities combined. A qualitative study exploring why physicians rate blacks patients' pain low is warranted.
authors.affiliation: University of Tennessee College of Medicine-Chattanooga Unit, Chattanooga, TN 37403, USA. lisa.staton@erlanger.org
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Staton
authors.forename: Mukta
authors.initials: M
authors.lastname: Panda
authors.forename: Ian
authors.initials: I
authors.lastname: Chen
authors.forename: Inginia
authors.initials: I
authors.lastname: Genao
authors.forename: James
authors.initials: J
authors.lastname: Kurz
authors.forename: Mark
authors.initials: M
authors.lastname: Pasanen
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mechaber
authors.forename: Madhusudan
authors.initials: M
authors.lastname: Menon
authors.forename: Jane
authors.initials: J
authors.lastname: O'Rorke
authors.forename: JoAnn
authors.initials: J
authors.lastname: Wood
authors.forename: Eric
authors.initials: E
authors.lastname: Rosenberg
authors.forename: Charles
authors.initials: C
authors.lastname: Faeslis
authors.forename: Tim
authors.initials: T
authors.lastname: Carey
authors.forename: Diane
authors.initials: D
authors.lastname: Calleson
authors.forename: Sam
authors.initials: S
authors.lastname: Cykert
mesh_terms: D000046:Academic Medical Centers; D001741:Black or African American / Q000523:psychology*; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D034462:Dissent and Disputes; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology*; D010147:Pain Measurement / Q000523:psychology / Q000592:standards*; D010465:Perception; D010817:Physician-Patient Relations; D011320:Primary Health Care; D014481:United States; D044465:White People / Q000523:psychology*
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid