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Oloruntoba O, Bergeron CD, Zhong L, Merianos AL, Sherman LD, Kew CL, Goidel RK, Smith ML. Pharmacological Prescribing and Satisfaction with Pain Treatment Among Non-Hispanic Black Men with Chronic Pain. Patient Prefer Adherence 2024; 18:187-195. [PMID: 38264322 PMCID: PMC10804868 DOI: 10.2147/ppa.s435652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Pharmacological strategies are often central to chronic pain management; however, pain treatment among non-Hispanic Black men may differ because of their disease profiles and healthcare interactions. However, less is known about pain medication prescribing and patients' satisfaction with pain treatment and management among non-Hispanic Black men with self-reported chronic pain. Purpose This study assessed factors associated with non-Hispanic Black men being prescribed/recommended narcotics/opioids for chronic pain and their satisfaction with pain treatment/management. Methods Data were analyzed from 286 non-Hispanic Black men with chronic pain who completed an internet-delivered questionnaire. Participants were recruited nationwide using a Qualtrics web-based panel. Logistic regression was used to identify factors associated with being prescribed/recommended narcotics/opioids for pain management treatment. Then, ordinary least squares regression was used to identify factors associated with their satisfaction level with the pain treatment/management received. Results On average, participants were 56.2 years old and 48.3% were prescribed/recommended narcotics/opioids for chronic pain. Men with more chronic conditions (Odds Ratio [OR] = 0.57, P = 0.043) and depression/anxiety disorders (OR = 0.53, P = 0.029) were less likely to be prescribed/recommended narcotics/opioids. Men who were more educated (OR = 2.09, P = 0.044), reported more frequent chronic pain (OR = 1.28, P = 0.007), and were allowed to participate more in decisions about their pain treatment/management (OR = 1.11, P = 0.029) were more likely to be prescribed/recommended narcotics/opioids. On average, men with more frequent chronic pain (B = -0.25, P = 0.015) and pain problems (B = -0.16, P = 0.009) were less satisfied with their pain treatment/management. Men who were allowed to participate more in decisions about their pain treatment/management reported higher satisfaction with their pain treatment/management (B = 0.55, P < 0.001). Conclusion Playing an active role in pain management can improve non-Hispanic Black men's satisfaction with pain treatment/management. This study illustrates the importance of patient-centered approaches and inclusive patient-provider interactions to improve chronic pain management.
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Affiliation(s)
- Oluyomi Oloruntoba
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
| | | | - Lixian Zhong
- Department of Pharmaceutical Sciences, Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Ledric D Sherman
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
- Center for Health Equity and Evaluation Research, Texas A&M University, College Station, TX, USA
| | - Chung Lin Kew
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - R Kirby Goidel
- Public Policy Research Institute, Texas A&M University, College Station, TX, USA
| | - Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
- Center for Health Equity and Evaluation Research, Texas A&M University, College Station, TX, USA
- Center for Community Health and Aging, Texas A&M University, College Station, TX, USA
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Baker TA, Morales KH, Brooks AK, Clark J, Wakita A, Whitt-Glover MC, Yu YZ, Murray M, Hooker SP. A biopsychosocial approach assessing pain indicators among Black men. FRONTIERS IN PAIN RESEARCH 2023; 4:1060960. [PMID: 36860329 PMCID: PMC9968840 DOI: 10.3389/fpain.2023.1060960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/11/2023] [Indexed: 02/15/2023] Open
Abstract
Introduction The lack of empirical evidence documenting the pain experience of Black men may be the result of social messaging that men are to project strength and avoid any expression of emotion or vulnerability. This avoidant behavior however, often comes too late when illnesses/symptoms are more aggressive and/or diagnosed at a later stage. This highlights two key issues - the willingness to acknowledge pain and wanting to seek medical attention when experiencing pain. Methods To better understand the pain experience in diverse raced and gendered groups, this secondary data analysis aimed to determine the influence identified physical, psychosocial, and behavioral health indicators have in reporting pain among Black men. Data were taken from a baseline sample of 321 Black men, >40 years old, who participated in the randomized, controlled Active & Healthy Brotherhood (AHB) project. Statistical models were calculated to determine which indicators (somatization, depression, anxiety, demographics, medical illnesses) were associated with pain reports. Results Results showed that 22% of the men reported pain for more than 30 days, with more than half of the sample being married (54%), employed (53%), and earning an income above the federal poverty level (76%). Multivariate analyses showed that those reporting pain were more likely to be unemployed, earn less income, and reported more medical conditions and somatization tendencies (OR=3.28, 95% CI (1.33, 8.06) compared to those who did not report pain. Discussion Findings from this study indicate that efforts are needed to identify the unique pain experiences of Black men, while recognizing its impact on their identities as a man, a person of color, and someone living with pain. This allows for more comprehensive assessments, treatment plans, and prevention approaches that may have beneficial impacts throughout the life course.
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Affiliation(s)
- Tamara A. Baker
- Department of Psychiatry, University of North Carolina, School of Medicine, Chapel Hill, NC, United States,Correspondence: Tamara A. Baker
| | - Knashawn H. Morales
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - Amber K. Brooks
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston salem, NC, United States
| | | | - Anna Wakita
- University of North Carolina, Gillings School of Global Public Health Chapel Hill, Chapel Hill, NC, United States
| | | | - Yelia Z. Yu
- Department of Psychiatry, University of North Carolina, School of Medicine, Chapel Hill, NC, United States
| | | | - Steven P. Hooker
- College of Health and Human Services, San Diego State University, San diego, CA, United States
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Resnick B, Galik E, Kolanowski A, VanHaitsma K, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K, Renn C, Dorsey SG. The Relationship Between Pain, Function, Behavioral, and Psychological Symptoms of Dementia and Quality of Life. Pain Manag Nurs 2022; 23:55-61. [PMID: 34353739 PMCID: PMC8807789 DOI: 10.1016/j.pmn.2021.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/17/2021] [Accepted: 07/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study evaluated the association between age, sex, comorbidities, cognition, and administration of opioids with pain and the impact of all of these variables plus function, agitation, resistiveness to care, and depression on quality of life among residents in nursing home with severe dementia. DESIGN This was a descriptive study using baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia implementation study. METHODS Model testing was done using structural equation modeling. The sample included 553 residents from 55 nursing homes with a mean age of 83.88 (standard deviation = 10.44) and mean Brief Interview of Mental Status of 4.30 (standard deviation = 3.50). RESULTS There were significant associations showing those who were older, male, had fewer comorbidities, better cognition, and were black were more likely to have pain. Pain, in combination with the demographic and descriptive variables, explained 32% of the variance in function, 75% of the variance in depression, 88% of the variance in agitation, 98% of the variance in resistiveness to care, and 92% of the variance in quality of life. The model however did not show a good fit to the data. SETTING The study was done in 55 nursing homes in Maryland and Pennsylvania. PARTICIPANTS/SUBJECTS A total of 553 residents were included in the study. CONCLUSIONS The model did not have a good fit with the data which likely was due to the lack of variance in outcomes. The hypothesized paths, with the exception of opioid use, were significant.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland.
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Ann Kolanowski
- Pennsylvania State University, Nursing Sciences Building, University Park, Pennsylvania
| | - Kimberly VanHaitsma
- Pennsylvania State University, Nursing Sciences Building, University Park, Pennsylvania
| | - Marie Boltz
- Pennsylvania State University, Nursing Sciences Building, University Park, Pennsylvania
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Jeanette Ellis
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Liza Behrens
- Pennsylvania State University, Nursing Sciences Building, University Park, Pennsylvania
| | - Karen Eshraghi
- Pennsylvania State University, Nursing Sciences Building, University Park, Pennsylvania
| | - Cynthia Renn
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Susan G Dorsey
- University of Maryland School of Nursing, Baltimore, Maryland
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Song C, Marshall GL, Reed A, Baker TA, Thorpe RJ. Examining the Association of Pain and Financial Hardship Among Older Men by Race in the United States. Am J Mens Health 2021; 15:15579883211049605. [PMID: 34587818 PMCID: PMC8488413 DOI: 10.1177/15579883211049605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/29/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022] Open
Abstract
Pain associated with financial hardship among older men varies by race. The purpose of this study was to examine the association of financial hardship with the presence of pain in men 50 years and older by race. Using the Health and Retirement Study (HRS) 2010 wave, bivariate and multivariate logistic regression models were used to assess the association between four financial hardship indicators and total financial hardship as a composite score, and the presence of pain by race. Among White men, the association between the presence of pain and hardship controlling for demographic factors was statistically significant across four indicators and one composite score: ongoing financial hardship (OR = 1.29, 95% CI [1.02, 1.64]), food insecurity (OR = 2.55, 95% CI [1.51, 4.31]), taking less medication due to cost (OR = 2.12, 95% CI [1.40, 3.22]), difficulty paying bills (OR = 1.36, 95% CI [1.07, 1.73]), and total financial hardship (OR = 1.27, 95% CI [1.12, 1.44]). Among African American men, the association between the presence of pain and taking less medication due to cost (OR = 2.99, 95% CI [1.31, 6.85]) was significant. With increasing comorbidities among older adults, particularly African Americans, it is imperative to fully understand the mechanisms of this underexplored area in both the pain and financial hardship literature.
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Affiliation(s)
- Chiho Song
- School of Social Work, University of
Washington, Seattle, WA, USA
| | | | - Alyssa Reed
- School of Public Health, University of
Washington, Seattle, WA, USA
| | - Tamara A. Baker
- School of Medicine, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Roland J. Thorpe
- Program for Research on Men’s Health,
Hopkins Center for Health Disparities Solutions, Johns Hopkins University,
Baltimore, MD, USA
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5
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Morales ME, Yong RJ. Racial and Ethnic Disparities in the Treatment of Chronic Pain. PAIN MEDICINE 2021; 22:75-90. [PMID: 33367911 DOI: 10.1093/pm/pnaa427] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To summarize the current literature on disparities in the treatment of chronic pain. METHODS We focused on studies conducted in the United States and published from 2000 and onward. Studies of cross-sectional, longitudinal, and interventional designs were included. RESULTS A review of the current literature revealed that an adverse association between non-White race and treatment of chronic pain is well supported. Studies have also shown that racial differences exist in the long-term monitoring for opioid misuse among patients suffering from chronic pain. In addition, a patient's sociodemographic profile appears to influence the relationship between chronic pain and quality of life. Results from interventional studies were mixed. CONCLUSIONS Disparities exist within the treatment of chronic pain. Currently, it is unclear how to best combat these disparities. Further work is needed to understand why disparities exist and to identify points in patients' treatment when they are most vulnerable to unequal care. Such work will help guide the development and implementation of effective interventions.
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Affiliation(s)
- Mary E Morales
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - R Jason Yong
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Wilson JD, Lanzkron S, Pecker LH, Bediako SM, Han D, Beach MC. Psychosocial and Clinical Risk Factors Associated with Substance Use in Observational Cohort of Patients with Sickle Cell Disease. Subst Use Misuse 2020; 55:2205-2212. [PMID: 32762425 PMCID: PMC8208322 DOI: 10.1080/10826084.2020.1797807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) experience high rates of chronic pain, and have a high burden of mental health comorbidities shown to negatively influence health. There is limited research on substance use among individuals with SCD. Objective: The aim of this study is to measure the prevalence of substance use in patients with SCD and determine whether psychosocial or clinical risk factors are associated with substance use. Methods: This study was conducted as part of an observational study of patients with SCD at two academic medical centers. We asked participants (ages 15 and older) about the lifetime use of heroin, cocaine, amphetamines, and marijuana/cannabis. We measured stigma, depression, urban life stress, pain catastrophizing, and asked about a brief pain inventory. Results: Of 258 participants, 24.9% (n = 71) reported substance use. Marijuana was the most common substance used (22.5%; n = 65). The mean depressive score met criteria for positive screen amongst individuals who reported a history of substance use (mean 10.7(5.76)). Adjusting for age, sex, yearly family income, and education level, odds of substance use increased with higher levels of internalized stigma (aOR: 1.38; 95% CI: 1.07, 1.77; p = 0.012); higher urban life stress scores (aOR 1.06; 95% CI: 1.01, 1.12; p = 0.017) and higher pain catastrophizing scores (aOR: 1.03; 95% CI: 1.01, 1.06; p = 0.008). Conclusions: Among individuals with SCD who endorse substance use, there was markedly more stress and distress with higher rates of depression and poorer quality of life. Interventions focusing on improving distress tolerance and coping to not only pain, but also social stressors, might reduce substance use.
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Affiliation(s)
- J. Deanna Wilson
- Division of General Internal Medicine, University of Pittsburgh, PA
| | - Sophie Lanzkron
- Department of Hematology, Johns Hopkins University School of Medicine
| | - Lydia H. Pecker
- Department of Pediatric Hematology, Johns Hopkins University School of Medicine
| | - Shawn M. Bediako
- Department of Psychology, University of Maryland, Baltimore County, MD
| | - Dingfen Han
- Division of General Internal Medicine, Johns Hopkins University School of Medicine
| | - Mary Catherine Beach
- Division of General Internal Medicine, Johns Hopkins University School of Medicine
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Baker TA, Vásquez E, Minahan JA. Variability of Pain Outcomes and Physical Activity Among a Diverse Sample of Older Men: Is It More Than Just Race? Gerontol Geriatr Med 2019; 5:2333721419878587. [PMID: 31633001 PMCID: PMC6767716 DOI: 10.1177/2333721419878587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/31/2019] [Accepted: 09/04/2019] [Indexed: 11/24/2022] Open
Abstract
There is a compendium of data documenting the increasing number of older adults.
This suggests the continued need to understand identified health outcomes across
domains of pain and physical activity, particularly among older men. Therefore,
the aim of this study was to evaluate race similarities and/or differences in
pain and rates of physical activity among White, Black, and Hispanic men 60+
years of age. Data were taken from the Health and Retirement Study, a
longitudinal panel study surveying a representative sample of people in the
United States. Logistic regression analysis was used to examine associations
between race and pain and the odds of regular physical activity. Results showed
that Black men were less likely to participate in light or moderate/vigorous
physical activity. Similarly, pain increased the odds of physical activity among
Hispanics, but decreased the odds of physical activity among White men. Findings
may reflect a number of factors that impact the well-being of what it means to
experience pain and physical functioning, while also assuming a masculine
identity. This perspective may allow for a better understanding of short- and
long-term implications of the pain experience and the pain and physical
functioning dyad among this group of men.
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Baker TA, Clay OJ, Johnson-Lawrence V, Minahan JA, Mingo CA, Thorpe RJ, Ovalle F, Crowe M. Association of multiple chronic conditions and pain among older black and white adults with diabetes mellitus. BMC Geriatr 2017; 17:255. [PMID: 29084525 PMCID: PMC5663150 DOI: 10.1186/s12877-017-0652-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 10/22/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Aging is often associated with the challenge of navigating daily tasks with a painful chronic medical illness. Yet, there is concern of the number of older adults impacted with more than one chronic condition. Despite the increasing number of adults diagnosed with diabetes and comorbid chronic illnesses, there remains a lack of understanding in how multiple illnesses relate to experiences of pain. To assess the association between multiple chronic conditions and pain, this study aimed to identify clusters of chronic medical conditions and their association with pain among a sample of older Black and White adults diagnosed with diabetes. METHODS Two hundred and thirty-six participants responded to a series of questions assessing pain frequency and severity, as well as health and social characteristics. A factor analysis was used to categorize clusters of medical conditions, and multiple regression models were used to examine predictors of pain. RESULTS Seven of the assessed chronic medical conditions loaded on three factors, and accounted for 57.2% of the total variance, with heart disease (factor 1) accounting for 21.9%, musculoskeletal conditions (factor 2) for another 18.4%, and factor 3 (microvascular diseases) accounting for a final 16.9% of the variability among the chronic medical conditions. Covariate-adjusted models showed that fewer years of education and higher scores on the microvascular and musculoskeletal conditions factors were associated with higher pain frequency, with the musculoskeletal conditions factor being the strongest predictor. CONCLUSIONS Findings from this study compliment existent literature underscoring the prevalence and importance of comorbid diagnoses in relation to pain. Examining health-related factors beyond a single disease diagnosis also provides an opportunity to explore underlying disease co-occurrences that may persist beyond organ system classifications.
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Affiliation(s)
- Tamara A. Baker
- Department of Psychology, University of Kansas, Lawrence, KS USA
| | - Olivio J. Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Vicki Johnson-Lawrence
- Department of Public Health and Health Sciences, University of Michigan-Flint, Flint, MI USA
| | | | - Chivon A. Mingo
- Gerontology Institute, Georgia State University, Atlanta, GA USA
| | - Roland J. Thorpe
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Fernando Ovalle
- Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
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Ruta NS, Ballas SK. The Opioid Drug Epidemic and Sickle Cell Disease: Guilt by Association. PAIN MEDICINE 2016; 17:1793-1798. [DOI: 10.1093/pm/pnw074] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Reinard K, Nerenz DR, Basheer A, Tahir R, Jelsema T, Schultz L, Malik G, Air EL, Schwalb JM. Racial disparities in the diagnosis and management of trigeminal neuralgia. J Neurosurg 2016; 126:368-374. [PMID: 26967783 DOI: 10.3171/2015.11.jns151177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A number of studies have documented inequalities in care and outcomes for a variety of clinical conditions. The authors sought to identify racial and socioeconomic disparities in the diagnosis and treatment of trigeminal neuralgia (TN), as well as the potential underlying reasons for those disparities, which could serve as areas of focus for future quality improvement initiatives. METHODS The medical records of patients with an ICD-9 code of 350.1, signifying a diagnosis of TN, at the Henry Ford Medical Group (HFMG) in the period from 2006 to 2012 were searched, and clinical and socioeconomic data were retrospectively reviewed. Analyses were conducted to assess potential racial differences in subspecialty referral patterns and the specific type of treatment modality undertaken for patients with TN. RESULTS The authors identified 652 patients eligible for analysis. Compared with white patients, black patients were less likely to undergo percutaneous ablative procedures, stereotactic radiosurgery, or microvascular decompression (p < 0.001). However, there was no difference in the likelihood of blacks and whites undergoing a procedure once they had seen a neurosurgeon (67% vs 70%, respectively; p = 0.712). Blacks and whites were equally likely to be seen by a neurologist or neurosurgeon if they were initially seen in either the emergency room (38% vs 37%, p = 0.879) or internal medicine (48% vs 50%, p = 0.806). Among patients diagnosed (268 patients) after the 2008 publication of the European Federation of Neurological Societies and the American Academy of Neurology guidelines for medical therapy for TN, fewer than 50% were on medications sanctioned by the guidelines, and there were no statistically significant racial disparities between white and black patients (p = 0.060). CONCLUSIONS According to data from a large database from one of the nation's largest comprehensive health care systems, there were significant racial disparities in the likelihood of a patient undergoing a procedure for TN. This appeared to stem from outside HFMG from a difference in referral patterns to the neurologists and neurosurgeons.
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Affiliation(s)
- Kevin Reinard
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - David R Nerenz
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Rizwan Tahir
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Timothy Jelsema
- Wayne State University School of Medicine, Detroit, Michigan
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Ghaus Malik
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Ellen L Air
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Medical Group, and.,Wayne State University School of Medicine, Detroit, Michigan
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Abstract
PURPOSE The persistence of health disparities in the U.S. has necessitated additional research on race-related health disparities among Americans. Remarkably little research has examined race differences in persons with headache disorders, even though 45 million Americans experience episodic or chronic headaches annually. This review paper examined peer-reviewed publication to examine potential race differences in persons with headache disorders in the areas of headache epidemiology, headache characteristics, psychiatric comorbidity, treatment utilization, and treatment outcomes. PROCEDURES A multi-database search (PubMed, Web of Science, PsychlNFO) identified U.S. studies that enrolled racially diverse samples of persons with headache disorders and qualitatively examined potential race-related disparities. MAIN FINDINGS Compared to their Caucasian counterparts, African American headache patients are more likely to (i) be diagnosed with comorbid depressive disorders; (ii) report headaches that are more frequent and severe in nature, (iii) have their headaches under-diagnosed and/or undertreated; and (iv) discontinue treatment prematurely, regardless of socioeconomic status. PRINCIPAL CONCLUSIONS State of the science treatments for chronic headaches are efficacious; unfortunately, race-related disparities prevent African American headache patients from benefiting from these treatments. Research is needed that enables African Americans with severe headaches to access current headache treatments to alleviate headache burden on the African American community.
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13
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Glover TL, Goodin BR, Horgas AL, Kindler LL, King CD, Sibille KT, Peloquin CA, Riley JL, Staud R, Bradley LA, Fillingim RB. Vitamin D, race, and experimental pain sensitivity in older adults with knee osteoarthritis. ARTHRITIS AND RHEUMATISM 2012; 64:3926-35. [PMID: 23135697 PMCID: PMC3510313 DOI: 10.1002/art.37687] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 08/23/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Low circulating serum levels of 25-hydroxyvitamin D (referred to hereafter as vitamin D) have been correlated with many health conditions, including chronic pain. Recent clinical practice guidelines define vitamin D levels <20 ng/ml as deficient and levels of 21-29 ng/ml as insufficient. Vitamin D insufficiency, including the most severe levels of deficiency, is more prevalent in black Americans. Ethnic and race group differences have been reported in both clinical and experimental pain, with black Americans reporting increased pain. The purpose of this study was to examine whether variations in vitamin D levels contribute to race differences in knee osteoarthritis pain. METHODS The sample consisted of 94 participants (74% women), including 45 blacks and 49 whites with symptomatic knee osteoarthritis. Their average age was 55.8 years (range 45-71 years). Participants completed a questionnaire on knee osteoarthritis symptoms and underwent quantitative sensory testing, including measures of sensitivity to heat-induced and mechanically induced pain. RESULTS Blacks had significantly lower levels of vitamin D compared to whites, demonstrated greater clinical pain, and showed greater sensitivity to heat-induced and mechanically induced pain. Low levels of vitamin D predicted increased experimental pain sensitivity, but did not predict self-reported clinical pain. Group differences in vitamin D levels significantly predicted group differences in heat pain and pressure pain thresholds at the index knee and ipsilateral forearm. CONCLUSION These data demonstrate that race differences in experimental pain are mediated by differences in the vitamin D level. Vitamin D deficiency may be a risk factor for increased knee osteoarthritis pain in black Americans.
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Affiliation(s)
- T L Glover
- University of Florida, Gainesville, FL 32610, USA.
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14
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Hastie BA, Riley JL, Kaplan L, Herrera DG, Campbell CM, Virtusio K, Mogil JS, Wallace MR, Fillingim RB. Ethnicity interacts with the OPRM1 gene in experimental pain sensitivity. Pain 2012; 153:1610-1619. [PMID: 22717102 DOI: 10.1016/j.pain.2012.03.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 02/28/2012] [Accepted: 03/21/2012] [Indexed: 01/13/2023]
Abstract
Robust interindividual variation in pain sensitivity has been observed, and recent evidence suggests that some of the variability may be genetically mediated. Our previous data revealed significantly higher pressure pain thresholds among individuals possessing the minor G allele of the A118G SNP of the mu-opioid receptor gene (OPRM1) compared with those with 2 consensus alleles. Moreover, ethnic differences in pain sensitivity have been widely reported. Yet, little is known about the potential interactive associations of ethnicity and genotype with pain perception. This study aimed to identify ethnic differences in OPRM1 allelic associations with experimental pain responses. A total of 247 healthy young adults from three ethnic groups (81 African Americans; 79 non-white Hispanics; and 87 non-Hispanic whites) underwent multiple experimental pain modalities (thermal, pressure, ischemic, cold pressor). Few African Americans (7.4%) expressed the rare allele of OPRM1 compared to non-Hispanic whites and Hispanics (28.7% vs. 27.8%, respectively). Across the entire sample, OPRM1 genotype did not significantly affect pain sensitivity. However, analysis in each ethnic group separately revealed significant genotype effects for most pain modalities among non-Hispanic-whites (P<.05) but not Hispanics or African Americans. The G allele was associated with decreased pain sensitivity among whites only; a trend in the opposite direction emerged in Hispanics. The reasons for this dichotomy are unclear; they may involve ethnic differences in haplotypic structure, or A118G may be a tag-SNP linked to other functional polymorphisms. These findings demonstrate an ethnicity-dependent association of OPRM1 genotype with pain sensitivity. Additional research is warranted to uncover the mechanisms influencing these relationships.
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Affiliation(s)
- Barbara A Hastie
- Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, Gainesville, FL, USA Genoptix Medical Laboratory, Carlsbad, CA, USA Centers for Disease Control and Prevention, Atlanta, GA, USA Department of Psychiatry and Behavioral Science, Johns Hopkins University, Baltimore, MD, USA Department of Psychology and Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, FL, USA Malcom Randall V.A. Medical Center, Gainesville, FL, USA
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Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health 2011; 11:770. [PMID: 21978149 PMCID: PMC3201926 DOI: 10.1186/1471-2458-11-770] [Citation(s) in RCA: 800] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 10/06/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain is an enormous problem globally. Estimates suggest that 20% of adults suffer from pain globally and 10% are newly diagnosed with chronic pain each year. Nevertheless, the problem of pain has primarily been regarded as a medical problem, and has been little addressed by the field of public health. DISCUSSION Despite the ubiquity of pain, whether acute, chronic or intermittent, public health scholars and practitioners have not addressed this issue as a public health problem. The importance of viewing pain through a public health lens allows one to understand pain as a multifaceted, interdisciplinary problem for which many of the causes are the social determinants of health. Addressing pain as a global public health issue will also aid in priority setting and formulating public health policy to address this problem, which, like most other chronic non-communicable diseases, is growing both in absolute numbers and in its inequitable distribution across the globe. SUMMARY The prevalence, incidence, and vast social and health consequences of global pain requires that the public health community give due attention to this issue. Doing so will mean that health care providers and public health professionals will have a more comprehensive understanding of pain and the appropriate public health and social policy responses to this problem.
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Affiliation(s)
- Daniel S Goldberg
- Department of Bioethics & Interdisciplinary Studies, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Mailstop 641, Greenville, N.C. 27834, USA
| | - Summer J McGee
- Department of Health Policy & Management, University of Kansas School of Medicine/KU Medical Center, Center for Practical Bioethics, The Harzfeld Building, 1111 Main St. Ste. 500 Kansas City, MO 64105, USA
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Drwecki BB, Moore CF, Ward SE, Prkachin KM. Reducing racial disparities in pain treatment: The role of empathy and perspective-taking. Pain 2011; 152:1001-1006. [DOI: 10.1016/j.pain.2010.12.005] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/04/2010] [Accepted: 12/02/2010] [Indexed: 12/30/2022]
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