Disparities in Pain: Ethical Issues

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Note from editor: The following is the report and newest recommendations from the AAPM Council on Ethics, which are now included in the “AAPM Ethics Charter.” All comments are welcome. The American Academy of Pain Medicine (AAPM) endorses the World Health Organization declaration that pain relief is a human right. The Academy advocates strongly for access to high-quality pain care for all persons, seeking to overcome any and all inequities that exist. The AAPM embraces the American Medical Association's statement on disparities, affirming that “disparities in medical care based on immutable characteristics such as race must be avoided. Whether such disparities in health care are caused by treatment decisions, differences in income and education, sociocultural factors, or failures by the medical profession, they are unjustifiable and must be eliminated. Physicians should examine their own practices to ensure that racial prejudice does not affect clinical judgment in medical care”[1]. While federal agencies have paid increasing attention to health care disparities in recent years [2], the impact of pain on individual patient's lives, their families, and society are notably absent in most federal research agency's strategic plans and position statements. The reality today is that there has been little impetus or effort among agencies of influence to promote, no less uphold, an acceptable standard of pain care among all groups of patients. There continue to be major disparities based on patient sociodemographic factors (e.g., race, ethnicity, socioeconomic status [SES], age, gender) for all types of pain (i.e., nociceptive and neuropathic pain) and across all settings (i.e., inpatient and outpatient settings) [3]. Overall, minorities report significantly more psychological and physical morbidity (e.g., post-traumatic stress disorder and disability) than non-Hispanic whites across the age continuum [4,5]. Respondents of an American Pain Society (APS) and AAPM survey …