Published on February 14, 2013 at 6:56 AM
Dr. Hausmann and colleagues suggest that "providing pain management support to primary care providers in the form of training on recommended guidelines and assistance with managing patients on long-term opioid regimens could improve overall adherence to recommended guidelines."
In an accompanying commentary, Megan Crowley-Matoka, PhD, of the Medical Humanities and Bioethics Program, Feinberg School of Medicine, Northwestern University, Chicago, says, "Pain management remains a persistent and pervasive problem across the practice of medicine. Despite strong consensus about the clinical, ethical, and economic importance of better managing pain, serious problems with both quality and equity continue to be routinely reported. The findings of Hausmann et al. suggest that, even for patients who overcome the barriers to receiving opioids, implementation of guideline recommendations is highly uneven and often racially disparate. Yet it is difficult to fully interpret what these data really tell us about the quality or equity of pain care, because we still know far too little regarding the efficacy of many of these practices, as well as what their appropriate level of use should be for most patients - much less how their differential use may affect black and white patients. Further complicating matters is the fact that so many of these practices associated with good pain care also run serious risk of being used by clinicians - and experienced by patients - in ways that are both punitive and prejudicial. These findings push us to move beyond this important first step of asking whether these practices are used, to examine more thoroughly and rigorously why and how they are used, and what outcomes are thus achieved."