Factors that Affect Adequate Analgesia in African Americans with Cancer Pain

Abstract

PURPOSE: Receiving adequate analgesia is problematic for African Americans with cancer pain. The majority of studies highlights the existing disparities between African Americans and Caucasians in pain management. There is a lack of research focusing on the etiology of these disparities, specifically on what causes prescriptions for inadequate analgesics, especially for African Americans. The purpose of this study was to characterize the adequacy of analgesia received by African Americans with cancer pain and to elucidate what patient characteristics contributed to receiving adequate analgesia. Methods: Secondary analysis of baseline data from an intervention study of African Americans with cancer pain. The Pain Management Index (PMI) was calculated for 302 African Americans with cancer pain to characterize the adequacy of the analgesics received for their reported pain score. Structure equation modeling was utilized to determine which patient factors (age, gender, presence of caregiver, employment status, educational level, cancer metastasis, perceived control over pain, pain-related distress, pain intensity, functional status) led to adequate analgesia. Results: Patients who reported worse pain received stronger analgesics. Forty percent of African Americans with cancer pain did not receive adequate analgesia based on the analgesic class prescribed. Cancer metastasis (p = .03) was the only significant predictor of a greater likelihood of receiving adequate analgesia. No other patient factors were found that affected analgesic prescriptions. Conclusions: Forty percent of African Americans with cancer pain received inadequate analgesia. No characteristics specific to African Americans with cancer pain led to receiving adequate analgesia. Cancer metastasis was the only factor that significantly contributed to receiving adequate analgesia. Future studies must be done to determine whether this is the same for other races to elucidate if the disparity identified in this study was solely based on race. Interventions must then be developed to reduce the disparities.