Race, ethnicity, and pain treatment: striving to understand the causes and solutions to the disparities in pain treatment.

Pain in the United States is widely recognized to be undertreated; however, the capacity to treat pain has never been greater.2 The causes of this undertreatment are varied. As we focus on pain and why it is too often ineffectively treated, we also discover that this undertreatment afflicts some more than others. What divides the some from the others isn’t limited to one factor, but one particularly disturbing factor is race and ethnicity. Racial and ethnic minority populations are at higher risk for oligoanalgesia, or the ineffective treatment of pain. Only through further study of the differences in pain treatment based on race and ethnicity can we develop strategies to reduce the disparities in care. Racial and ethnic disparities in health care in the United States have received greater focus in the last ten years than any time in our history. Numerous studies have revealed that racial and ethnic minority groups often receive different and less optimal management of their health care than white Americans. Research studies have identified inequalities in the treatment of black Americans for early stage lung cancer,3 ischemic heart disease,4 and access to invasive cardiac procedures5 as well as cadaveric renal transplantations.6 Studies have shown that a patient’s race has a substantial effect on the treatment provided and the mortality rates among Medicare beneficiaries7 and veterans.8 Scholars have concluded that persistent racial disparities in access to health care and treatment result from unequal health care that is the legacy of a racially divided health system.9 In October 1999, the Henry J. Kaiser Family Foundation published a comprehensive review of the literature on racial and ethnic differences in access to health services from 1985 to 1999.10 This major study did not, however, include a review of racial and ethnic differences related to pain treatment. It is time that this occurred. This paper has three aims. It will (1) review the published literature on disparities in the treatment of pain based on race and ethnicity; (2) outline what may be some of the causes for disparities in pain treatment; and (3) provide suggestions for future health-services research regarding the causes and solutions to pain treatment disparities.