Author: Sopyda Yin
According to the International Association for Study of Pain, pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” Chronic pain is the sixth most costly condition in the United States, and approximately 65 million Americans report episodes of chronic back pain in their lifetime. While clinicians define chronic pain to last from three to six months or more, different racial and ethnic groups can experience substantial prevalence and treatment for pain-related conditions. There is growing literature discussing the racial disparities in pain-related conditions. Studies report that African Americans experience a heavier burden of pain or pain-related suffering compared to non-Hispanic whites. Even though African Americans report enduring a greater sense of pain, they are among the overrepresented racial group to be discriminated against by healthcare professionals when seeking pain management and treatment.
The prevalence of pain among individuals differs vastly on age, sex, family history, lifestyle, environment, and pharmacogenomics, and pharmacokinetics of analgesics. Pharmacogenomics studies the individual’s genetic attributes that affect their response to therapeutic drugs. Pharmacokinetics studies the pharmacological movement of drugs in the body. While there is substantial evidence illustrating the incongruity of individual groups prescribing pain medication, studies have shown that equitable access to pain medication yields inconsistent results for different ethnic groups. For instance, pharmacogenetic and pharmacokinetic researchers discovered that African Americans and Asian Americans metabolize morphine differently compared to non-Hispanic whites. More research is needed to evaluate the effects of pharmacogenomics and pharmacokinetics in pain.
However, numerous studies examine the social conditions in different racial and ethnic groups that influence pain and treatment. One study examines the patient factor and reports that African Americans have a stronger link with emotions and pain behaviors than non-Hispanic whites and rely on passive coping strategies that may be maladaptive to pain. A cross-sectional study reported that although pain prevalence rates were similar across racial and ethnic groups, African Americans and Hispanics were more likely to report severe pain than non-Hispanic whites. African Americans have a lower pain threshold for cold, heat, pressure, and ischemia (shortage of oxygen to the heart muscle). This suggests that the perceived intensity of pain sensation is discriminative between non-Hispanic whites and African Americans. African Americans’ sensitivity to painful stimuli is higher and more unpleasant. While there is little study on the underlying physiological mechanism that influences disparities in pain perception, a recent study found that African Americans have enhanced temporal summation of pain but reduced diffuse noxious (pain) inhibitory control. Therefore, endogenous pain-regulatory systems in observed ethnic differences cannot be fully explained from sociocultural factors, and that neurophysiological mechanism may play a potential contributor in such disparities.
Racial and ethnic minorities reported receiving less adequate care for acute and chronic pain compared to non-Hispanic whites. One leading cause for pain management disparities in minority individuals is pain intensity underreporting. The clinicians’ lack of cultural and social awareness of an individual’s pain and use of narcotic analgesics reflects one contribution to such disparities. As a result, this might explain why clinicians may under report pain because racial bias deviates trust between healthcare professionals and minority groups. Clinicians need to acknowledge their inflicted bias regarding pain management and realize the risk it may harm minority patients. Pain medicine is a complex case study that requires intensive understanding from a pathophysiological level to a social-economic level. Future approaches to reduce such disparities are to acknowledge the existing racial and systemic barriers in our healthcare system and improve equitable care in marginalized areas.
