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Minorities Get Less Pain Relief

Blacks, Hispanics, Women Given Less, if Any, Pain Medication

By Sid Kirchheimer
WebMD Medical News


Oct. 8, 2003 -- The latest evidence to suggest that race plays a role in the quality of medical care received: A new report, based on 180 previously published studies, shows that blacks and Hispanics are less likely to be given pain medications than whites, even when they report higher levels of suffering.


And this trend appears to be widespread -- occurring in hospital emergency rooms, nursing homes, and in treating chronic conditions.


"Across the board, racial and ethnic minorities have less access to pain medications," says anesthesiologist and lead researcher Carmen R. Green, MD, of the University of Michigan Medical School. "And that applies to acute pain, chronic pain, cancer pain, and even Workman's Compensation issues."


Her report, published in the September issue of Pain Medicine, is the latest in what is amounting to overwhelming evidence that doctors treat minorities and white patients differently.


Nearly 1,000 studies have already shown that minority patients are more likely to get inferior healthcare than whites -- even when they have similar incomes, health insurance, and access to medical treatment, says H. Jack Geiger, MD, ScD, of the City University of New York Medical School. He is a longtime researcher on racial disparities in health care and helped prepare a 700-page report by the National Academies' Institute of Medicine (IOM) on how racism affects health outcomes.


Green's study documents several startling examples: Hispanics with broken arms or legs were twice as likely as whites to go without pain medication during emergency-room visits, while black cancer patients in nursing homes were 64% more likely not to get pain medication than whites. And these studies checked for such factors as income, language proficiency, and insurance.


And Green says there's new evidence that minorities with chronic pain are more likely to report a greater sensitivity and disability to pain.


Previous studies have suggested that minorities are also less likely to get certain medical procedures -- ranging from emergency care for heart attacks to elected procedures such as knee replacement surgery.


"I don't think physicians are purposely giving minority patients less pain medication, but we need to ask questions in our practices about how we make our treatment decisions, and why," Green tells WebMD. "Most physicians, if you ask them, say they give the same quality of care to all their patients."


But studies in her paper indicate that doctors report having "lesser outcome goals" when treating chronic pain in minority and women patients.


"If you look at women and men with the same pain problems, the evidence shows that women consistently get lesser care -- even when actors (and not real patients) present the same pain problem," she says.


Past research has suggested that while doctors get some of the blame, minorities may also be more distrustful of their doctors and more problems communicating with them.


The take-home message to you: "It's unclear why these differences persist, and more research is needed," says Green. "But patients should know that they don't have to live with pain. If you're not getting the answers you want or have lesser access to certain treatments, at some level, you have to demand better treatment. There's no reason why some patients can get a certain medication but others cannot because they have a different ZIP code."

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