Back to Top
EC: Why are minorities at risk for inadequate pain treatment?
CG: Much of the research thus far has looked at African-Americans and Hispanics, but little is known about Native Americans. Other populations at risk include the very young and the very old, and those who do not speak English well. There are many reasons including unequal access to care, problematic assessment, clinician variability in decisions making, physician-patient communication, as well as patient education, knowledge, and attitudes. Minority patients also are more likely to have other co-morbid conditions, but are less likely to be referred to specialty care. These issues may be due to communication or economic barriers but there are also other clinical and patient related factors that must be explored.
Our individual values often come in to play when caring for patients. We feel more comfortable with someone who looks like us, and talks like us, comes from the same community or culture. However, to disentangle health disparities we have to be willing to listen to someone who tells their story in a different way.
Back to Top
EC: What have you learned from your more recent research?
CG: In 2005, we published a paper that looked at socio-demographic differences in access to opioid pain medication at pharmacies across Michigan. We looked at race and income. My interest in doing this was the result of a discussion with a patient who told me she had to travel 30 miles from her home to buy her prescription pain medicine.
We surveyed pharmacists to see if their pharmacy carried sufficient opioid analgesic supplies, which we defined as stocking at least one long-acting, one short-acting, and one combination opioid analgesic. We labeled pharmacies as minority if more than 70% of the residents in the zip code were minority, and labeled them white if more than 70% of the residents in the zip code were white. We compared high-income zip codes to low-income zip codes.
Our research showed that both the racial composition and the income of the community were factors in access to medication, with significant differences related more to race than income. When comparing minority and white pharmacies, the pharmacies located in white zip codes stocked sufficient supplies of opioid analgesics more frequently (86.9%) than pharmacies in minority areas (54.2%). White pharmacies in zip codes with greater than median income were 13 times more likely than minority pharmacies in the same income range to have sufficient opioid supplies. In lower income zip codes, pharmacies in white areas were approximately 54 times as likely to have a sufficient opioid analgesic supply. Our conclusion was that Michigan pharmacies in minority zip codes were 52 times less likely to carry sufficient supplies, therefore, regardless of income people living in minority neighborhoods faced additional barriers to care. For the patient, this means facing barriers to obtaining their medication: a need to travel, and facing the risk of questions being raised about why the prescription was not filled closer to home.
Back to Top
EC: What do you think is the next step to solving the problem of racial and ethnic disparities in pain management?
CG: There are many different aspects of the problem that need to be addressed. First and foremost is the issue of educating healthcare providers about pain management -beginning with medical school and ending with continuing medical education. If the fundamentals of pain management are not instilled early in the medical education process, it makes it much more difficult to change attitudes and treatment approaches. When students start their training they are taught to explore and uncover as much information pertaining to the patient as a whole as possible. In many cases, when nearing the end of the educational process, this is reduced to just identifying the "chief complaint", and streamlining the process as much as possible. We must teach young clinicians to understand the importance of, and respect for one of the most important pieces of the puzzle of managing pain -the assessment. Only through better education and access to resources for all health care providers about pain and its appropriate management, can access to quality pain care begin to be more available to everyone, including patients receiving unequal levels of care now.
Currently, there are not enough pain medicine specialists. Thus, we all have to get better at assessing and treating the needs of all patients. Nurses and physicians who work in primary care and handle the majority of responsibility for the care of sick people in the United States, need to be educated and ready to confront these issues in their daily practice, as that is where these patients are most likely to present- regardless of their race and ethnicity. Primary care continues to be our front line in providing quality pain care.
Green CR, Tait RC (Editors): Disparities in Pain Care. Pain Medicine, Special Issue. 2005; 6:1-102.
Green CR, Tait RC, Gallagher RM: The unequal burden of pain: Disparities and differences. Pain Medicine. 2005;6:1-2.
Green CR, Ndao-Brumblay SK, West B, Washington T. Differences in prescription opioid analgesic availability: comparing minority and white pharmacies across Michigan. J Pain. 2005;6:689-699.
Green CR, Baker T, Ndao-Brumblay SK: Patient attitudes regarding healthcare utilization and referral: a descriptive comparison in African- and Caucasian Americans with chronic pain. Journal of the National Medical Association. 2004; 96(1):31-42.
Green CR: Racial disparities in access to pain treatment. Pain Clinical Updates. 2004; 12(6):4.