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Racial differences in opioid use for chronic nonmalignant pain

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Abstract

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.

DESIGN, SETTING, AND PARTICIPANTS: 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.

CONCLUSION: 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.

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Author information

Authors and Affiliations

  1. Eastern Virginia Medical School, Norfolk, Va, USA

    Ian Chen MD

  2. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    James Kurz MD, Tim Carey MD, MPH, Diane Calleson PhD & Sam Cykert MD

  3. University of Vermont, Burlington, Vt, USA

    Mark Pasanen MD

  4. George Washington University, Washington, DC, USA

    Charles Faselis MD

  5. University of Tennessee College of Medicine-Chattanooga Unit, Chattanooga, Tenn, USA

    Mukta Panda MD

  6. East Carolina University, Greenville, NC, USA

    Lisa J. Staton MD

  7. University of Texas, San Antonio, Tex, USA

    Jane O’Rorke MD

  8. University of Pittsburgh Medical Center, McKeesport, Pa, USA

    Madhusudan Menon MD

  9. Emory University, Atlanta, Ga, USA

    Inginia Genao MD

  10. University of Louisville, Louisville, Ky, USA

    JoAnn Wood MD

  11. University of Miami, Miami, Fla, USA

    Alex J. Mechaber MD

  12. University of Florida, Gainesville, Fla, USA

    Eric Rosenberg MD, MSPH

Authors
  1. Ian Chen MD
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  2. James Kurz MD
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  3. Mark Pasanen MD
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  4. Charles Faselis MD
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  5. Mukta Panda MD
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  6. Lisa J. Staton MD
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  7. Jane O’Rorke MD
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  8. Madhusudan Menon MD
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  9. Inginia Genao MD
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  12. Eric Rosenberg MD, MSPH
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  13. Tim Carey MD, MPH
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  14. Diane Calleson PhD
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  15. Sam Cykert MD
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Corresponding author

Correspondence to Ian Chen MD.

Additional information

The authors certify that they have no conflict of interest regarding affiliations or financial involvement with any organization or entity regarding the subject matter or materials discussed in the manuscript.

The UNC Faculty Development Fellowship in Primary Care 1-D14-HP00169-01 was supported by the Bureau of Health Professions of the Department of Health and Human Services Health Resources and Services Administration (HRSA).

Dr. Carey is supported in part by funding from the Agency for Healthcare Research and Quality, Grant number P01 HS10861, and by the National Center on Minority Health and Health Disparities, Grant number P60 MD00244.

Dr. Wood was supported in part by a Professional Development Grant, University of Louisville.

Dr. Kurz was supported in part by the UNC University Research Council, University of North Carolina, Chapel Hill.

Dr. Chen was supported in part by the Excellence in Primary Care Research Training Grant D14-HP-00182 from the Department of Health and Human Services Health Resources and Services Administration (HRSA).

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Chen, I., Kurz, J., Pasanen, M. et al. Racial differences in opioid use for chronic nonmalignant pain. J GEN INTERN MED 20, 593–598 (2005). https://doi.org/10.1007/s11606-005-0105-5

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  • DOI: https://doi.org/10.1007/s11606-005-0105-5

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