Disparities In Pain Treatment Research Articles

Racial and Ethnic Disparities in the Prescribing of Pain Medication in US Primary Care Settings, 1999-2019: Where Are We Now?

Policy initiatives have attempted to reduce healthcare inequalities in the USA, but evidence on whether these initiatives have reduced racial and ethnic disparities in pain treatment in primary care is lacking. To determine whether racial and ethnic disparities in medication prescribed for pain in primary care settings have diminished over a 21-year period from 1999 to 2019. An annual, representative cross-sectional probability sample of visits to US primary care physicians, taken from the National Ambulatory Medical Care Survey. Pain-related visits to primary care physicians. Prescriptions for opioid and non-opioid analgesics. Of 599,293 (16%) sampled visits, 94,422 were pain-related, representing a population-weighted estimate of 143 million visits made annually to primary care physicians for pain. Relative risk analysis controlling for insurance, pain type, and other potential confounds showed no difference in pain medication prescribed between Black and White patients (p = .121). However, White patients were 1.61 (95% CI 1.32-1.97) and Black patients 1.57 (95% CI 1.26-1.95) times more likely to be prescribed opioids than a more underrepresented group consisting of Asian, Native-Hawaiian/Pacific-Islander, and American-Indian/Alaska-Natives (ps < .001). Non-Hispanic/Latino patients were 1.32 (95% CI 1.18-1.45) times more likely to receive opioids for pain than Hispanic/Latino patients (p < .001). Penalized cubic spline regression found no substantive narrowing of disparities over time. These findings suggest that additional intervention strategies, or better implementation of existing strategies, are needed to eliminate ethnic and racial disparities in pain treatment towards the goal of equitable healthcare.

Trends in Racial Inequalities in the Administration of Opioid and Non-opioid Pain Medication in US Emergency Departments Across 1999-2020.

Despite initiatives to eradicate racial inequalities in pain treatment, there is no clear picture on whether this has translated to changes in clinical practice. To determine whether racial disparities in the receipt of pain medication in the emergency department have diminished over a 22-year period from 1999 to 2020. We used data from the National Hospital Ambulatory Medical Care Survey, an annual, cross-sectional probability sample of visits to emergency departments of non-federal general and short-stay hospitals in the USA. Pain-related visits to the ED by Black or White patients. Prescriptions for opioid and non-opioid analgesics. A total of 203,854 of all sampled 625,433 ED visits (35%) by Black or White patients were pain-related, translating to a population-weighted estimate of over 42 million actual visits to US emergency departments for pain annually across 1999-2020. Relative risk regression found visits by White patients were 1.26 (95% CI, 1.22-1.30; p<0.001) times more likely to result in an opioid prescription for pain compared to Black patients (40% vs. 32%). Visits by Black patients were also 1.25 (95% CI, 1.21-1.30; p<0.001) times more likely to result in non-opioid analgesics only being prescribed. Results were not substantively altered after adjusting for insurance status, type and severity of pain, geographical region, and other potential confounders. Spline regression found no evidence of meaningful change in the magnitude of racial disparities in prescribed pain medication over 22 years. Initiatives to create equitable healthcare do not appear to have resulted in meaningful alleviation of racial disparities in pain treatment in the emergency department.

Qualitative Analysis of Patient Perspectives of Buprenorphine After Transitioning From Long-Term, Full-Agonist Opioid Therapy Among Veterans With Chronic Pain

Guidelines recommend consideration of modification, tapering, or discontinuation of long-term, full-agonist opioid therapy when harms outweigh benefits; one alternative to tapering or discontinuing full-agonist opioids for the management of chronic pain is switching to the partial agonist buprenorphine. As the use of buprenorphine for pain expands, understanding the patient experience during and after the transition to buprenorphine is critical. We conducted 45- to 60-minute semistructured qualitative interviews with 19 patients to understand the experiences of patients with chronic pain actively maintained on buprenorphine after previously receiving full-agonist, long-term opioid therapy. Patients were recruited from 2 medical centers via provider referral. Through thematic analysis, 5 overall themes were identified, including satisfaction with buprenorphine, the importance of preconceptions about buprenorphine, experiences with transitions, patient-provider communication, and potential contributions to racial disparities in pain care. While we heard a range of experiences, most patients were satisfied with buprenorphine, reporting either equivalent pain control to their previous regimens or reporting less analgesia but improved functioning due to a reduction in side effects (eg, mental clarity). Patients also emphasized the importance of a nonjudgmental, patient-centered approach, including education about the risks and benefits of buprenorphine. The few Black patients interviewed all reported limited access to pain care, which is consistent with the well-documented existence of racial disparities in access to pain treatment. As buprenorphine is used more frequently for pain management, provider education focused on pain treatment disparities, patient-centered approaches informed by motivational interviewing, and increasing acceptance of buprenorphine as an option for pain are needed. PerspectiveQualitative analyses of patient experiences transitioning from full-agonist opioids to buprenorphine for chronic pain revealed general satisfaction. Patients reflected on functioning, tradeoffs between analgesia and side effects, patient-centered care, and access to treatment, highlighting how future research should focus on outcomes valued by patients.

From Awareness to Action: Pathways to Equity in Pain Management.

This commentary calls for a shift in the identification, analysis, and treatment of disparities in pain management. We provide context and research that summarize social and structural determinants that contribute to disparities across multiple levels of the pain management continuum. Informed by the evidence, we provide guideposts for mitigating disparities in the assessment, diagnosis, and care provided to those experiencing pain, with a focus on highlighting the specific needs of marginalized communities and the importance of culturally appropriate and context-specific approaches to pain management. This commentary informs efforts to promote equity by identifying areas of concern, guiding interventions, and advocating for policies that aim to eliminate disparities in pain treatment. Researchers, health care providers, and organizations can collectively work to provide equitable culturally sensitive pain management and improve overall patient outcomes.

The Experience of BIPOC Living with Chronic Pain in the USA: Biopsychosocial Factors that Underlie Racial Disparities in Pain Outcomes, Comorbidities, Inequities, and Barriers to Treatment.

This review synthesizes recent findings related to the biopsychosocial processes that underlie racial disparities in chronic pain, while highlighting opportunities for interventions to reduce disparities in pain treatment among BIPOC. Chronic pain is a prevalent and costly public health concern that disproportionately burdens Black, Indigenous, and people of color (BIPOC). This unequal burden arises from an interplay among biological, psychological, and social factors. Social determinants of health (e.g., income, education level, and lack of access or inability to utilize healthcare services) are known to affect overall health, including chronic pain, and disproportionately affect BIPOC communities. This burden is exacerbated by exposure to psychosocial stressors (i.e., perceived injustice, discrimination, and race-based traumatic stress) and can affect biological systems that modulate pain (i.e., inflammation and pain epigenetics). Further, there are racial/ethnic disparities in pain treatment, perpetuating the cycle of undermanaged chronic pain among BIPOC.

Healthcare Access and Delivery During the COVID-19 Pandemic for Black Veterans with Chronic Pain: a Qualitative Study.

The COVID-19 pandemic led to significant disruptions in healthcare and rapid increases in virtual healthcare delivery. The full effects of these shifts remain unknown. Understanding effects of these disruptions is particularly relevant for patients with chronic pain, which typically requires consistent engagement in treatment to maximize benefit, and for Black patients, given documented racial disparities in pain treatment and telehealth delivery. To understand how Black patients with chronic pain experienced pandemic-related changes in healthcare delivery. In-depth, semi-structured qualitative interviews PARTICIPANTS: Black veterans with chronic pain. Participants described decreased ability to self-manage their chronic pain, obtain nonpharmacological services such as physical therapy, see their primary care providers, and schedule surgery. Most did not believe telehealth met their needs, describing feeling inadequately assessed for their pain and noting that beyond renewing prescriptions, telehealth visits were not that useful. Some believed their communication with their providers suffered from a lack of in-person contact. Others, however, were willing to accept this tradeoff to prevent possible exposure to COVID-19, and some appreciated the convenience of being able to access healthcare from home. Black patients with chronic pain described mostly negative effects from the shift to telecare after the pandemic's onset. Given existing disparities and likely persistence of virtual care, research on the longer-term effects of virtual pain care for Black patients is needed.

Ultrasound-Guided Erector Spinae Plane Block in Emergency Department for Abdominal Malignancy Pain: A Case Report.

Severe breakthrough pain is a common occurrence in patients with cancer and is responsible for thousands of emergency department (ED) visits each year. While opioids are the current mainstay of treatment, they have multiple limitations including inadequate control for a quarter of patients with cancer. The ultrasound-guided erector spinae plane block (ESPB) has been used in the ED to effectively treat pain for pathologies such as acute pancreatitis, since it provides somatic and visceral analgesia. In this case report we describe the use of an ESPB to treat breakthrough pain safely and effectively in a 54-year-old female with a history of metastatic colon cancer. The ESPB may have utility in addressing well documented disparities in pain treatment in the ED, but additional research is needed to understand side effects, duration of pain control, and clinical outcomes of the ESPB.

Over-Rating Pain is Overrated: A Fundamental Self-Other Bias in Pain Reporting Behavior

Wide-spread cultural beliefs influence personal experiences and clinical treatment of pain, yet are often unexamined and unchallenged in the pain literature. The common cultural belief that people generally over-report or exaggerate pain is familiar, reflected in discordant patient-provider pain assessments, and compounded in the context of disparities in pain treatment. However, no studies have directly measured the prevalence of this belief among the general population, nor challenged the validity of this assumption by assessing normative pain reporting in clinical settings. Results of an initial and replication study suggest that reporting pain accurately “as-is” is the norm, yet most people still believe that others normatively over-report pain. We refer to the phenomenon by which most people report their pain as they experience it while paradoxically believing that others over-report their pain as the fundamental pain bias, and suggest this false perception may contribute to larger scale pain stigma and poor outcomes for people in pain. We also identify counter-stereotypical patterns of pain reporting among groups (ie, women, Latinx Americans) that face more disparate care. Results reinforce the need for respecting patient pain reports, and suggest that distrust surrounding others’ pain experiences is prevalent in society. PerspectiveMost people claim to report their pain as accurately as possible, while simultaneously perpetuating common cultural beliefs that others over-report their pain. This fundamental pain bias highlights a pervasive misconception that likely contributes to patient-provider mistrust and broader cultural pain stigma.

A Good Time to Be Born

A Good Time to Be Born

White Ignorance in Pain Research: Racial Differences and Racial Disparities.

Racial disparities in pain treatment are well documented. Such disparities are explained with reference to factors related to providers, health care structures, and patient behaviors. Racial differences in pain experiences, although well documented, are less well understood. Explanations for such differences usually involve genetic or psychological factors. Here, we argue that racial differences in pain experiences might also be explained by disparities in pain treatment. Based on what we know about the nature of pain, particularly the cognitive and affective aspects of the phenomenon, it is likely that disparities in the treatment of racialized patients can lead to significant racial differences in pain experience that show up at the population level. We argue that the failure of research programs to consider this causal factor is an example of white ignorance. We also consider several implications of the link between racial disparities in pain treatment and racial differences in pain experience.

The Impact of Patient Race and Prior Misuse Behaviors on Opioid Tapering Decisions

Given the recent opioid crisis, providers are being encouraged to taper prescription opioids for chronic pain. Racial disparities in pain treatment are well documented, but little is known about how patient race may influence provider opioid tapering decisions. Research and theory also suggest that patient race may interact with opioid use and adherence behaviors to impact provider tapering decisions. In this online study, 136 providers made opioid tapering decisions for 8 computer-simulated patients (4 Black, 4 White) with chronic pain. Text vignettes described all patients as taking prescription opioids, but half reported previous "yellow flag" misuse behaviors (e.g., early refill) and half reported medication adherence. Multilevel modeling indicated that patient history of opioid misuse increased providers' odds of changing the opioid prescription (OR=4.7, p=.03) and of endorsing the goal of discontinuing opioids (vs. maintaining at a lower dose; OR=11.0, p<.01). Patient history of opioid misuse also increased providers' odds of starting a long-acting opioid and decreasing the dose of the current opioid (vs. discontinuing opioids immediately; OR=4.2, p=.06). For providers who started a long-acting opioid, there was a significant race-by-misuse interaction on their target MED/day. For White patients, a history of opioid misuse increased providers' odds of prescribing a higher dose of the long-acting opioid (OR=3.4, p<.01), but no differences emerged for Black patients. Neither patient race nor opioid use history impacted the rate of tapering or the MED/day target for short-acting opioids. Our results indicate that the clinically-relevant information of patient opioid use history impacted provider opioid tapering decisions. Although patient race largely did not affect the tapering decisions assessed herein, prior work has found Black patients undergo more opioid-related monitoring than White patients. Future studies are needed to further understand the nuances of racial disparities in pain care during the opioid crisis. Grant support from National Institutes of Health under Award Numbers R01MD008931 and R01MD008931-05S.

Contralateral Limb Pain Is Prevalent, Persistent, and Impacts Quality of Life of Veterans with Unilateral Upper-Limb Amputation

ABSTRACT Introduction Individuals with upper-limb amputation (ULA) have increased risk for contralateral limb pain (CLP), and further study of CLP in ULA is needed. Study objectives were to: (1) describe CLP frequency, intensity, and 1-year change; (2) identify factors associated with CLP; and (3) quantify associations between CLP, health-related quality of life (HRQoL), and disability (QuickDASH). Methods A total of 776 veterans with unilateral ULA were surveyed at baseline, and 562 were surveyed again at 1 year. Participants reported CLP frequency and intensity and nonamputated limb conditions. Multivariable models examined factors associated with CLP, as well as associations between CLP intensity and HRQOL (physical component score and mental component score) and disability (QuickDASH). Results Contralateral limb pain prevalence was 72.7% (baseline) and 71.6% (follow-up); 59.8% had persistent pain. Contralateral limb conditions and neck and residual limb pain were associated with higher odds of CLP. Black race (vs White), back pain (vs without), and age 45 to 65 years (vs 18–45 years) were associated with greater CLP intensity. Female sex (vs male) and use of cosmetic prostheses (vs body-powered) were associated with lower intensity. The mental component scores were 2.7 and 6.6 points lower for moderate and severe CLP, respectively; the physical component scores were 4.2 and 8.4 points lower for moderate and severe CLP; and QuickDASH scores were 9.4 and 20.7 point higher for moderate and severe CLP, compared with none to mild pain. Conclusions Findings suggest that overreliance on the nonamputated limb, leading to CLP, occurs regardless of amputation level or prosthesis use. Further research is needed to understand whether disparities in pain treatment exist by race. Contralateral limb pain is prevalent and persistent in veterans with ULA. Moderate to severe CLP is associated with worse HRQOL and greater disability. Efforts are needed to prevent and treat ULA CLP pain. Clinical Relevance Clinicians caring for persons with unilateral ULA should evaluate the contralateral upper limb and refer patients to appropriate therapies to address painful conditions. Persons with ULA should be educated about the risks of development of CLP and be provided with strategies to minimize overuse when possible.

Race Deficits in Pain Detection: Medical Providers and Laypeople Fail to Accurately Perceive Pain Authenticity Among Black People

Across six studies (N = 904), we suggest a novel mechanism for race disparities in pain treatment: Perceiver deficits in discriminating real from fake pain for Black (relative to White) individuals. Across Studies 1–4, White participants (Studies 1–4) and Black participants (Study 2) were better at discerning authentic from inauthentic pain expressions for White targets than for Black targets. This effect emerged for both subtle (Studies 1 and 2) and intense (Studies 3 and 4) pain stimuli. Studies 5 and 6 examined consequences for medical care decisions by examining pain treatment recommendations by laypeople (Study 5) and pain authenticity judgments by medical providers (Study 6). This work advances theory in pain perception, emotion judgment, and intergroup relations. It also has practical significance for identifying unexplored mechanisms causing racial disparities in medical care.

Poverty and pain: Low-SES people are believed to be insensitive to pain

Across 10 experiments (N = 1584), we investigated biases in assumptions about pain sensitivity as an explanation for pain treatment disparities across socioeconomic status (SES). We find that lower-SES individuals are believed to feel less pain than higher-SES individuals (Studies 1a-1c), and this effect persists across target demographics including race (i.e., White individuals, Black individuals) and gender (i.e., men, women; Studies 2–3). Next, we examined two potential mechanisms underlying the effect of SES on pain sensitivity: dehumanization and beliefs about life hardship (Studies 4–5). We observed supporting evidence for the differential life hardship account of pain sensitivity biases across SES. Finally, we investigated the downstream consequences of biased pain perception of pain sensitivity for medical care and treatment recommendations, finding that both lay participants (Studies 6–7) and medical providers (Study 8) believe that low-SES individuals are less sensitive to pain and therefore require less intensive pain management. This systematic bias in judgments of pain sensitivity across SES has implications for psychological theory and equitable pain treatment.

Obesity and the Receipt of Prescription Pain Medications in the US.

Little is known about disparities in pain treatment associated with weight status despite prior research on weight-based discrepancies in other realms of healthcare and stigma among clinicians. To investigate the association between weight status and the receipt of prescription analgesics in a nationally representative sample of adults with back pain, adjusting for the burden of pain. Cross-sectional analyses using the Medical Expenditure Panel Survey (2010-2017). Five thousand seven hundred ninety-one civilian adults age ≥ 18 with back pain. We examine the odds of receiving prescription analgesics for back pain by weight status using logistic regression. We study the odds of receiving (1) any pain prescription, (2) three pain prescription categories (opioid only, non-opioid only, the combination of both), and (3) opioids conditional on having a pain prescription. The odds of receiving pain prescriptions increase monotonically across weight categories, when going from normal weight to obesity II/III, despite adjustments for the burden of pain. Relative to normal weight, higher odds of receiving any pain prescription is associated with obesity I (OR = 1.30 [95% CI = 1.04-1.63]) and obesity II/III (OR = 1.72 [95% CI = 1.36-2.18]). Obesity II/III is also associated with higher odds of receiving opioids only (OR = 1.53 [95% CI = 1.16-2.02]), non-opioids only (OR = 1.77 [95% CI = 1.21-2.60]), and a combination of both (OR = 2.48 [95% CI = 1.44-4.29]). Obesity I is associated with increased receipt of non-opioids only (OR = 1.55 [95% CI = 1.07-2.23]). Conditional on having a pain prescription, the odds of receiving opioids are comparable across weight categories. This study suggests that, relative to those with normal weight, adults with obesity are more likely to receive prescription analgesics for back pain, despite adjustments of the burden of pain. Hence, the possibility of weight-based undertreatment is not supported. These findings are reassuring because individuals with obesity generally experience a higher prevalence of back pain. The possibility of over-treatment associated with obesity, however, may warrant further investigation.

Feasibility of an online health intervention for Latinas with chronic pain.

Chronic pain is a common health problem in the United States, and it is associated with numerous physical and mental health issues. Disparities in pain treatment are high for particular populations, including Latinos, who comprise a significant percent of the U.S. The purpose of this study was to develop and evaluate an online health education intervention for Spanish-speaking Latinas with chronic pain. The intervention was developed based on a biopsychosocial approach to treatment and targeted multiple domains including exercise, psychological wellbeing, regaining function, emotional wellbeing, sleep hygiene, and stress management. Through a mixed-method, single-arm design, this pilot study examined patients' and providers' acceptability of and satisfaction with the intervention, as well as the impact of the intervention on patients' knowledge, chronic pain self-efficacy, pain severity, and pain interference (measured pre and post intervention). Both chronic pain patients (n = 40) and provider participants (n = 10) reported high rates of participation, and high ratings for website features and website content. Patient participants also experienced a significant increase in knowledge regarding pain management and treatment options, and in chronic pain self-efficacy, as well as a significant decrease in pain interference. Although means for pain severity were lower at the posttest session, this change was not significant. Overall, results indicate that an online educational intervention that targets Spanish-speaking Latinas with chronic pain is feasible, potentially impactful, and that there is a need for such interventions. Recommendations include additional content and interactive features that could improve satisfaction, engagement, and impact. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

How race features in pain-treatment disparities.

British Journal of Community NursingVol. 25, No. 7 TreatmentsHow race features in pain-treatment disparitiesAysha MendesAysha MendesE-mail Address: [email protected]Freelance journalist specialising in healthcare and psychologySearch for more papers by this authorAysha MendesPublished Online:2 Jul 2020https://doi.org/10.12968/bjcn.2020.25.7.360AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bonilla-Silva E. Racism without racists: color-blind racism and the persistence of racial inequality in America. 4th edn. Plymouth: Rowman and Littlefield; 2014 Google ScholarCox D. The trauma trap: what's causing inequalities in emergency care? 2018. https://tinyurl.com/ya5yrkow (accessed 19 June 2020) Google ScholarDrewicki B, Moore C, Ward S, Prkachin K. Reducing racial disparities in pain treatment: the role of empathy and perspective-taking. Pain. 2011; 152(5):1001–1006. https://doi.org/10.1016/j.pain.2010.12.005 Crossref, Medline, Google ScholarGuardian. Prof Donna Kinnair on racism in the NHS: ‘in every community, BAME patients suffer the most’. 2020. https://tinyurl.com/ybr6fy4x (accessed 19 June 2020) Google ScholarHarrison EM, Docherty AB, Barr B et al.. Ethnicity and outcomes from COVID-19: the ISARIC CCP-UK prospective observational cohort study of hospitalised patients. 2020. https://doi.org/10.2139/ssrn.3618215 Google ScholarHoffman KM, Trawalter S, Axt JR, Norman Oliver M. Recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci USA. 2016; 113(16)4296–4301. https://doi.org/10.1073/pnas.1516047113 Crossref, Medline, Google ScholarKennel J. Racial disparities in EMS. 2019. https://tinyurl.com/ybj7h5pc (accessed 19 June 2020) Google ScholarNational Institute for Health Research. First drug to reduce mortality in hospitalised patients with respiratory complications of COVID-19 found. 2020. https://tinyurl.com/y9exbjgr (accessed 19 June 2020) Google ScholarPublic Health England. Disparities in the risk and outcomes of COVID-19. 2020. https://tinyurl.com/y7s6o69g (accessed 19 June 2020) Google Scholar FiguresReferencesRelatedDetails 2 July 2020Volume 25Issue 7ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 2 July 2020 Published in print 2 July 2020 Information© MA Healthcare LimitedPDF download

Intergroup anxiety in pain care: impact on treatment recommendations made by white providers for black patients.

Race disparities in pain care are well-documented. Given that most black patients are treated by white providers, patient-provider racial discordance is one hypothesized contributor to these disparities. Research and theory suggest that providers' trait-level intergroup anxiety impacts their state-level comfort while treating patients, which, in turn, impacts their pain treatment decisions. To test these hypothesized relationships, we conducted a planned secondary analysis of data from a randomized controlled trial of a perspective-taking intervention to reduce pain treatment disparities. Mediation analyses were conducted on treatment decision data from white providers for black virtual patients with chronic pain. Results indicated that white providers with higher trait-level intergroup anxiety reported lower state-level comfort treating black patients and were thereby more likely to recommend opioid (indirect effect = 0.76, 95% confidence interval [CI]: 0.21-1.51) and pain specialty (indirect effect = 0.91, 95% CI: 0.26-1.78) treatments and less likely to recommend nonopioid analgesics (indirect effect = -0.45, 95% CI: -0.94 to -0.12). Neither trait-level intergroup anxiety nor state-level comfort significantly influenced provider decisions for physical therapy. This study provides important new information about intrapersonal and interpersonal contributors to race disparities in chronic pain care. These findings suggest that intergroup anxiety and the resulting situational discomfort encroach on the clinical decision-making process by influencing white providers' decisions about which pain treatments to recommend to black patients. Should these findings be replicated in future studies, they would support interventions to help providers become more aware of their trait-level intergroup anxiety and manage their state-level reactions to patients who are racially/ethnically different from themselves.

Racial/Ethnic Disparities in Pain Treatment: Evidence From Oregon Emergency Medical Services Agencies.

Despite the critical role that Emergency Medical Services (EMS) provides in the health care system, racial/ethnic treatment disparities in EMS remain relatively unexamined. To investigate racial/ethnic treatment disparities in pain assessment and pain medication administration in EMS. A retrospective analysis was performed on 25,732 EMS encounters from 2015 to 2017 recorded in the Oregon Emergency Medical Services Information System using multivariate logistic regression models to examine the role of patient race/ethnicity in pain assessment and pain medication administration among patients with a traumatic injury. Hispanic and Asian patients were less likely to receive a pain assessment procedure and all racial/ethnic patients were less likely to receive pain medications compared with white patients. In particular, regarding the adjusted likelihood of receiving a pain assessment procedure, Hispanic patients were 21% less likely [95% confidence interval (CI), 10%-30%; P<0.001], Asian patients were 31% less likely (95% CI, 16%-43%; P<0.001) when compared with white patients. Regarding the adjusted likelihood of receiving any pain medications, black patients were 32% less likely (95% CI, 21%-42%; P<0.001), Hispanic patients were 21% less likely (95% CI, 7%-32%; P<0.01), and Asian patients were 24% less likely (95% CI, 1%-41%; P<0.05) when compared with white patients. Racial/ethnic minorities were more likely to experience disadvantages in EMS treatment in Oregon. Hispanic and Asian patients who requested EMS services in Oregon for traumatic injuries were less likely to have their pain assessed and all racial/ethnicity patients were less likely to be treated with pain medications when compared with white patients.

"It's Better in a Group Anyway": Patient Experiences of Group and Individual Acupuncture.

Chronic pain is prevalent, burdensome, and costly, and there are ethnic and racial disparities in treatment. Acupuncture is effective and safe, but access is limited. Group acupuncture can decrease cost and increase capacity by decreasing clinic space needs and increasing patient volume per acupuncturist; however, the effectiveness and patient acceptability of group and individual session acupuncture have never been directly compared. The Acupuncture Approaches to Decrease Disparities in Pain Treatment (AADDOPT-2) study is a randomized comparative effectiveness trial of acupuncture for chronic pain. Semistructured in-depth interviews were conducted with a subset of patients enrolled in the trial. Outpatient clinics in an urban, low income area serving a primarily black and Hispanic population. Qualitative interviews were conducted with 46 patients; 23 in each arm of the AADDOPT-2 study. Patients were randomized to receive either individual acupuncture or acupuncture delivered in a small group. Transcripts of the interviews were analyzed using an inductive thematic framework to explore and compare the patient experience in group and individual settings. Patients in both study arms valued the pain relief, improved quality of life, and relaxation experienced during acupuncture. Privacy and mixed-sex groups were cited as a concern by a minority of patients; however, most of those randomized to the group setting noted that these concerns abated after initiating treatment. Differences between arms included the depth of the relationship with the acupuncturist and misgivings related to the treatment space. Group dynamics varied; some groups fostered a supportive, therapeutic interaction, while others were more reserved. Patients in both arms valued their acupuncture experience. Participants described both positive and negative aspects of the group setting.