Leveling the Playing Field: Recognizing and Rectifying Disparities in Management of Pain

Abstract

Fifty to seventy percent of primary care visits have a complaint of pain. Between 3.5 and 6 million patients with cancer experience pain. Over 23 million surgical patients will experience pain. And 53 million people in the United States will have pain due to injury. How pain is managed differs among segments of the population. People at particular risk of receiving inadequate management of pain include children, the elderly, people with a history of substance abuse, the mentally ill, women, minorities, and people of color. Pain has been undertreated, undermanaged, improperly assessed, and inadequately taught in our health professions schools. This issue of Pain Medicine is devoted to research on the issues of disparities in health status and delivery of health services for the poor, minority citizens, and segments of the population who are at risk for suboptimal access to healthcare and effective treatment. Our nation has achieved a remarkable improvement in life expectancy of its citizens during the 20th century. An infant born in 1900 had a life expectancy of 47 years. Among the major causes of death at that time were conditions such as pneumonia, diphtheria, tuberculosis, gastrointestinal infections, childhood communicable diseases, and vitamin deficiency disorders [1]. One hundred years later, the life expectancy of an infant born today in the United States is approximately 77 years, representing almost a doubling of life expectancy in our nation during the 20th century [2]. This is due to better nutrition, safer drinking water and improved sanitation, childhood immunizations, development of antibiotics, other antimicrobials, and other advances in health sciences. Advances in global longevity have occurred more in the past 40 years than in the previous 4000 years [3]. Improvements in public health and in medicine have greatly enhanced the lives of Americans during the …