title: Advancing a national agenda to eliminate disparities in pain care: directions for health policy, education, practice, and research.
abstract: BACKGROUND
  Pain is strongly associated with significant personal and societal costs. A crucial element of any initiative on pain must focus on eliminating pain care disparities that are pervasive throughout the United States health care settings.
  
  
  OBJECTIVE
  This report focuses on macro-level factors related to pain care disparities in the United States that may be amenable to policy interventions.
  
  
  METHODS
  We identify concrete opportunities for achieving equity in pain care, especially those occasioned by recent legislative changes in the United States health care system. An aggressive policy, advocacy, and research agenda is synthesized in five domains: 1) structural/system; 2) policy and advocacy; 3) workforce; 4) provider; and 5) research.
  
  
  RESULTS
  Inequities in pain care remain an important and neglected health policy concern. Many direct and indirect provisions within the Affordable Care Act (ACA) and other national initiatives that leverage on ACA offer opportunities to achieve equity in pain care. These include changes in insurance, in public, provider, and legislative education, in primary care and pain specialist training, improving workforce diversity, achieving uniformity in race/ethnicity data collection, emphasizing patient-centered outcomes research, and encouraging focus on pain care disparities within the comparative effectiveness research paradigm.
  
  
  CONCLUSIONS
  Recent national legislative initiatives within ACA are expected to generate multilevel efforts that will impact the flow of funding to address the pervasive issue of disparities. It is an opportune time for the pain community to take a lead in implementing a concerted agenda on pain care disparities in order to leverage these national initiatives.
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA. meghanis@nursing.upenn.edu
authors.forename: Salimah H
authors.initials: SH
authors.lastname: Meghani
authors.forename: Rosemary C
authors.initials: RC
authors.lastname: Polomano
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Tait
authors.forename: April H
authors.initials: AH
authors.lastname: Vallerand
authors.forename: Karen O
authors.initials: KO
authors.lastname: Anderson
authors.forename: Rollin M
authors.initials: RM
authors.lastname: Gallagher
mesh_terms: D035843:Biomedical Research / Q000331:legislation & jurisprudence / Q000639:trends*; D004502:Education, Medical, Continuing / Q000331:legislation & jurisprudence / Q000639:trends*; D004503:Education, Medical, Graduate / Q000331:legislation & jurisprudence / Q000639:trends*; D005006:Ethnicity / Q000331:legislation & jurisprudence; D006287:Health Planning Guidelines; D006291:Health Policy / Q000331:legislation & jurisprudence / Q000639:trends*; D054625:Healthcare Disparities / Q000331:legislation & jurisprudence / Q000639:trends*; D006801:Humans; D059408:Pain Management / Q000639:trends*; D014481:United States