Racial Disparities in Pain Management in Primary Care

Abstract

This descriptive, cross-sectional, secondary data analysis was conducted to examine racial disparities in pain management of primary care patients with chronic nonmalignant pain using chronic opioid therapy. Data from 891 patients, including 201 African Americans and 691 Caucasians were used to test an explanatory model for these disparities. We predicted that: (1) African American patients would report worse pain management and poor quality of life (QOL) than Caucasians; (2) the association between race and pain management would be mediated by perceived discrimination relating to hopelessness; and (3) poor pain management would negatively affect QOL. Results revealed significant differences between African Americans and Caucasians on pain management and QOL, with African Americans faring worse. The proposed mediational model, which included race, perceived discrimination, hopelessness, and pain management was supported: (1) African Americans compared to Caucasians had higher perceived discrimination, (2) perceived discrimination was positively associated with hopelessness, and (3) higher hopelessness was associated with worse pain management. Further, pain management predicted QOL. This is the first study in which an explanatory model for the racial disparities in pain management of primary care patients with chronic nonmalignant pain was examined. Perceived discrimination and hopelessness were implicated as explanatory factors for the disparities.

Keywords: Chronic nonmalignant pain; Model of racial disparities; Pain Management; perceived discrimination; racial and ethnic minorities.

Figure

Conceptual Model of Racial Disparities in Pain Management. Note. α = race - perceived discrimination path; β = perceived discrimination – mediator (Hopelessness) path; γ = mediator – pain management path; and δ = pain management – quality of life path; ++ A separate aim. Not part of the mediator factor.