7 Racial , Ethnic , and Sociodemographic Disparities

Unprecedented scientific advances have led to a better understanding of pain mechanisms and the ability to alleviate pain and suffering. Yet the literature continues to document the widespread and significant undertreatment of pain (especially for racial and ethnic minorities). Numerous studies describe stark differences in health and health care based upon race, ethnicity, gender, socioeconomic status, and age (1–3). Overwhelmingly, the literature provides evidence for inferior care of minorities. There is also considerable evidence that acute, chronic, and cancer pain have unique health implications in minority patients, low-income individuals, elderly persons, and women that are often unrecognized or overlooked (4–11). Furthermore, the pain complaints of racial and ethnic minorities receive less attention than those of Caucasians (regardless of the type of pain), putting them at significant risk for inferior quality pain care (12–15). Thus, several ethical challenges essential for health care planning in an increasingly aging and diversifying society exist (16,17). Like many chronic illnesses, chronic pain (i.e., nonmalignant or benign pain greater than equal to six months) significantly impairs overall health and wellbeing (18–20). However, most of the literature on disparities fail to address this chronic condition and when it is addressed, the focus is on acute and cancer pain (21–23). In addition, age, ethnicity, and sociodemographic factors may make certain populations more vulnerable to chronic pain (24). There is limited literature to guide us regarding the presenting symptoms, pain duration, and disability due to chronic pain, but it suggests that the health problems commonly seen in chronic pain patients [e.g., depression, posttraumatic stress disorder (PTSD)] are more problematic in minority and underserved populations (25,26). Because there is often a close association between race or ethnicity and income, living in poverty is an additional risk factor for poor health due to pain as well as inferior quality pain care (27). Overall, guidelines designed to improve and reduce barriers to chronic pain care have not adequately addressed disparities in pain care for potentially underserved and vulnerable populations or the ethical implications for disparate pain care (28–31). This chapter primarily focuses on disparities in chronic pain while providing an overview of disparities from an ethical perspective. More specifically, this chapter will address: