Racially Based Disparities in Pain Management: Something Old, Something New, But What to Do?

Abstract

In this issue of Pain Medicine , Montague and Green report data that add to a growing body of evidence of disparities in pain management correlated with race and ethnicity. In their study of breakthrough pain in 96 adults with advanced-stage solid neoplasms (breast, lung, prostate, and colorectal) and myeloma, they observed that self-identified “minorities” reported statistically significantly greater baseline pain severity and greater severity for BTP than whites did [1]. Other characteristics of pain and function, such as duration, quality, or location of breakthrough flares, and health-related quality of life scores were not statistically different between minorities and whites but trended to be worse in minorities. In one sense, this is the same, old story. As Montague and Green note, using the same measure that they used in this study—the Pain Management Index—Cleeland et al. reported in a serious of studies over more than 10 years that minorities (African Americans and Hispanics) were at higher risk for poorer cancer pain management than whites [2,3]. The new findings in this study extend the reporting of disparate outcomes in cancer pain management to the realm of breakthrough pain. In addition, the authors reported an interesting negative finding: there were no significant ethnic differences in patient coping as measured by the John Henryism Acting Coping Scale (JHACS), although men had higher scores than women. The JHACS scale is named for a mythical figure in African American culture who tried to succeed in work and life by controlling behavioral stressors through a single-minded coping strategy of hard work …