Minorities who experience pain don’t receive the same care as Caucasians

The first issue of Pain Medicine in 2005 will focus on the inequalities and differences in how pain is assessed and treated amongst various racial and ethnic minority groups. Data from the articles in this themed edition provide evidence that African Americans, Hispanics, American Indians and other racial and ethnic minorities do not receive optimal care in treatment for pain.

“Each article in this issue is important for its unique contribution to the literature on racial and ethnic differences in pain,” state editor Rollin M. Gallagher, MD, MPH and guest editors Carmen R. Green, MD and Raymond C. Tait, PhD in the issue’s introduction entitled, The unequal burden of pain: Disparities and differences. “Most interestingly, each article identifies commonalities in response to pain, the adverse impact of pain, and the under-treatment of pain across racial and ethnic groups that can be easily overlooked in our efforts to identify differences.”

Topics covered include differences in response to pain, ethical implications of racial disparities, age and gender as contributing factors to inequalities, and ultimately, unequal treatment. The papers range from racial differences in the ability to access pain medications, and differences in the response to pain based upon race and age, to work that focuses on workers compensation claims among Caucasians and African Americans.

Commentary by Louis W. Sullivan, MD, Secretary of the U.S. Department of Health and Human Services 1989-93, and Barry A. Eagel, MD discuss the history of health and health care disparities in the United States, emphasizing the disadvantages suffered by African Americans and Hispanics. They specifically focus on infant mortality, AIDS, diabetes and violence found more often among racial and ethnic minority groups, and particularly how factors such as health behavior, patient and physician attitudes, and inadequate access to resources contribute to gaps in health status. This commentary provides a platform for a discussion of the public health implications of disparities in general, and for pain in particular. The authors also note the importance of cultural competency for health care providers.

Additionally, Allen Lebovits, PhD, pain management specialist for 15 years and Co-Director of the New York University Pain Management Center contributes an editorial to this issue asking the question, “Are Some of Us More Equal?” and highlights the suggestion that “pain specialists provide better care and give faster attention to more profitable patients.” Lebovits notes how even in end-of-life care situations, services are more available to those who fit the white, upper-class mold.

Gallagher, Green and Tait present this issue as a “call for action” to address and rectify the “unequal burden of pain.” The editors believe that this is the first time that an entire issue has devoted to pain care for racial and ethnic minorities. They specifically ask for additional research and policy to address disparities in pain care based upon race and ethnicity. Readers can anticipate further coverage on the disparities and differences in pain medicine, as three more articles are scheduled to publish in future issues this year.