MSU study considers unequal pain treatment

Cultural differences, language barriers and a "legacy of a racially divided health system" are among the reasons racial and ethnic minorities do not receive equal treatment for pain relief in our country, says a Michigan State University professor who has studied the issue.

Vence Bonham, in a paper published in the current Journal of Law, Medicine & Ethics, said many factors play a part in the undertreatment of pain among minorities.

"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," he said. "Numerous studies have revealed that racial and ethnic minority groups often receive different and less optimal management of their health care than white Americans."

In his research, Bonham found more than 400 studies, published between 1990 and 2000, that addressed the issue of pain management. Of those, he focused on eight studies in which the primary objective was to investigate differences in pain treatment.

"The studies as a body of research paint the clear picture that one's race and ethnicity matter in the treatment of pain," Bonham said. "The common thread is that there are empirical data indicating differences in pain treatment based on the patient's racial and ethnic background."

The disparity in treatment, Bonham said, could be due to a number of factors, including health care provider concern about potential drug abuse, lack of resources with which to pay for analgesics, greater difficulty in assessing care and in filling analgesic prescriptions, and greater difficulty in assessing pain because of language and cultural barriers.

"In addition," Bonham said, "the studies found that inadequate treatment may result from the patient's fear of aggressive treatment or the patient's lack of assertiveness seeking care."

In his paper, Bonham also suggested that more research was needed in this area to determine the underlying causes.

"What the studies do as a body of research is make a very strong argument that this is an important area for further research, physician education and health advocacy to improve the treatment of pain for all people in our society," he said. "If we are to solve these disparities in treatment, we must study them and determine their causes."

Examples of these disparities abound, Bonham said. For example:

• Studies found that African Americans and Hispanics treated for long bone fracture in an emergency room setting generally did not receive equal treatment for pain.
• Minority patients were more likely to have had the severity of their pain underestimated by their physicians and to have reported that they needed strong pain medication.
• Another study found that outpatients with cancer who went to clinics that served ethnic and racial minority patients were three times more likely to be undermedicated than were patients in other settings.

Bonham is an assistant professor in MSU's Department of Medicine and Department of Osteopathic Surgical Specialties. He also is a Mayday Scholar. The Mayday Foundation is a private foundation that focuses on issues of pain management.