Background. The recent Institute of Medicine Report assessing the state of pain care in the United States acknowledged the lack of consistent data to describe the nature and magnitude of unrelieved ...pain and identify subpopulations with disproportionate burdens.
Objectives. We synthesized 20 years of cumulative evidence on racial/ethnic disparities in analgesic treatment for pain in the United States. Evidence was examined for the 1) magnitude of association between race/ethnicity and analgesic treatment; 2) subgroups at an increased risk; and 3) the effect of moderators (pain type, setting, study quality, and data collection period) on this association.
Methods. United States studies with at least one explicit aim or analysis comparing analgesic treatment for pain between Whites and a minority group were included (SciVerse Scopus database, 1989–2011).
Results. Blacks/African Americans experienced both a higher number and magnitude of disparities than any other group in the analyses. Opioid treatment disparities were ameliorated for Hispanics/Latinos for “traumatic/surgical” pain (P = 0.293) but remained for “non‐traumatic/nonsurgical” pain (odds ratio OR = 0.70, 95% confidence interval CI = 0.64–0.77, P = 0.000). For Blacks/African Americans, opioid prescription disparities were present for both types of pain and were starker for “non‐traumatic/nonsurgical” pain (OR = 0.66, 95% CI = 0.59–0.75, P = 0.000). In subanalyses, opioid treatment disparities for Blacks/African Americans remained consistent across pain types, settings, study quality, and data collection periods.
Conclusion. Our study quantifies the magnitude of analgesic treatment disparities in subgroups of minorities. The size of the difference was sufficiently large to raise not only normative but quality and safety concerns. The treatment gap does not appear to be closing with time or existing policy initiatives. A concerted strategy is needed to reduce pain care disparities within the larger quality of care initiatives.
These are changing times, for the world, for our specialty, and for Pain Medicine. The congressionally designated “Pain Decade” (2000–2010), the Middle East wars and subsequent military, Veterans ...Administration, IOM and IPRCC projects, and finally, spurred by the long simmering opioid overuse crisis, the recent Health and Human Services (HHS) Report, brought pain management to the forefront of healthcare 1. However, the pandemic’s devastation of national economies has siphoned away attention and healthcare resources from the projects addressing chronic pain’s prevention and management. As the acute global public health crisis of the coronavirus disease 2019 (COVID-19) pandemic gradually recedes, preexisting global public health problems of a more chronic nature, persisting for generations, such as hunger, depression, and chronic pain, will emerge once again more powerfully than ever as deserving of public health’s attention 2. Thus, managing the problem of pain, including its causal comorbidity with depression, suicide, and substance use disorder, and now complicated by the effects of COVID, will be even more challenging to address societally. Pain Medicine, with a reshaped Editorial Board in anticipation of these challenges, will play an important role in this effort. So let’s look back to inform our forward momentum in this role.
In Memoriam: Dr. Jeffrey Fudin Gallagher, Rollin M; Herndon, Chris; Harden, R. Norman
Pain medicine (Malden, Mass.),
08/2022, Letnik:
23, Številka:
8
Journal Article
The Veterans Health Administration (VHA) provides medical care for Veterans after leaving the military. The combination of multiple deployments and battlefield exposures to physical and psychological ...trauma results in a higher prevalence and complexity of chronic pain in Veterans than in the general public. The VHA and the Department of Defense work together to develop a single standard of stepped pain management appropriate for all settings from moment of injury or disease onset. This article describes the education, academic detailing, and clinical programs and policies that are transforming pain care in the VHA.
The opioid crisis creates challenges for cancer pain management. Acupuncture confers clinical benefits for chronic nonmalignant pain, but its effectiveness in cancer survivors remains uncertain.
To ...determine the effectiveness of electroacupuncture or auricular acupuncture for chronic musculoskeletal pain in cancer survivors.
The Personalized Electroacupuncture vs Auricular Acupuncture Comparative Effectiveness (PEACE) trial is a randomized clinical trial that was conducted from March 2017 to October 2019 (follow-up completed April 2020) across an urban academic cancer center and 5 suburban sites in New York and New Jersey. Study statisticians were blinded to treatment assignments. The 360 adults included in the study had a prior cancer diagnosis but no current evidence of disease, reported musculoskeletal pain for at least 3 months, and self-reported pain intensity on the Brief Pain Inventory (BPI) ranging from 0 (no pain) to 10 (worst pain imaginable).
Patients were randomized 2:2:1 to electroacupuncture (n = 145), auricular acupuncture (n = 143), or usual care (n = 72). Intervention groups received 10 weekly sessions of electroacupuncture or auricular acupuncture. Ten acupuncture sessions were offered to the usual care group from weeks 12 through 24.
The primary outcome was change in average pain severity score on the BPI from baseline to week 12. Using a gatekeeping multiple-comparison procedure, electroacupuncture and auricular acupuncture were compared with usual care using a linear mixed model. Noninferiority of auricular acupuncture to electroacupuncture was tested if both interventions were superior to usual care.
Among 360 cancer survivors (mean SD age, 62.1 12.7 years; mean SD baseline BPI score, 5.2 1.7 points; 251 69.7% women; and 88 24.4% non-White), 340 (94.4%) completed the primary end point. Compared with usual care, electroacupuncture reduced pain severity by 1.9 points (97.5% CI, 1.4-2.4 points; P < .001) and auricular acupuncture reduced by 1.6 points (97.5% CI, 1.0-2.1 points; P < .001) from baseline to week 12. Noninferiority of auricular acupuncture to electroacupuncture was not demonstrated. Adverse events were mild; 15 of 143 (10.5%) patients receiving auricular acupuncture and 1 of 145 (0.7%) patients receiving electroacupuncture discontinued treatments due to adverse events (P < .001).
In this randomized clinical trial among cancer survivors with chronic musculoskeletal pain, electroacupuncture and auricular acupuncture produced greater pain reduction than usual care. However, auricular acupuncture did not demonstrate noninferiority to electroacupuncture, and patients receiving it had more adverse events.
ClinicalTrials.gov Identifier: NCT02979574.
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