Whites More Likely to Get Narcotics for Pain. (Insurance Status, Age Also Factors)

Article excerpt

VANCOUVER, B.C. -- White patients with chronic nonmalignant pain are more likely to receive narcotics than black ones, even though black patients have significantly higher average pain scores, Dr. Mark E. Pasanen reported at the annual meeting of the Society of General Internal Medicine.

Unconscious physician bias regarding racial differences in pain-medication-seeking behavior seems to play a role in this treatment disparity said Dr. Pasanen of the University of Vermont, Burlington.

These were among the key findings to date from the Patient, Physician Perceptions of Pain (4P) Study The ongoing 12-center cross-sectional study was designed to explore the attitudes and behaviors of primary care physicians and their patients with chronic nonmalignant pain.

The 4P Study involves 463 patients with chronic nonmalignant pain and 458 primary care physicians, 87% of them internists. Overall, 68% of participating patients were women; 36% were currently taking narcotics; 41% had received physical therapy; and 33% had seen a rheumatologist, orthopedist, or pain specialist for their chronic pain.

Narcotics were being used by 32% of black and 45.7% of white patients, even though black patients had a significantly higher mean pain score: 6.7 on a validated 1-10 pain scale, compared with 5.6 for whites. In addition to race, other factors that were associated with narcotic use were insurance status, age, and degree of pain. Gender, duration of pain, income, and education level were not.

In a multiple logistic regression analysis, white race was associated with a 2.24-fold increased chance of receiving narcotics for chronic pain. There was no racial difference in the use of subspecialty care.

To learn more .about how physician attitudes might figure in this racial disparity in treatment, investigators turned to surveys completed by every participating physician. One survey assessed general attitudes toward patients with chronic pain; others addressed each patient encounter. …