Are demographics getting in the way of pain management?

By Theoni Varoudaki

Are demographics getting in the way of pain management?

By Theoni Varoudaki
Editor’s note: The following opinion piece was submitted as part of the inaugural “Op-ed Challenge” hosted by the University of Miami Graduate School. Open to all graduate students, entries were judged by media professionals.

Imagine that you are in pain. 

Maybe you stepped off a ladder and hurt your shoulder. The pain isn't intense enough for you to go to the doctor immediately, so you wait. Before you know it, the pain won't let you sleep, and you can't carry your groceries. You finally run to the doctor expecting they'll diagnose the underlying cause of your pain and relieve your symptoms. If you tell your doctor that your pain intensity is a 9 out of 10, you trust that the painkillers that they will prescribe you will be 9 out of 10 strong, right?  

Surprisingly, that's not always the case for patients in the U.S. 

Clinicians tend to prescribe fewer analgesics than needed to minorities and women and too many opioids and other pain medications to White non-Hispanic men. This practice has fueled the opioid epidemic and increased struggles with pain management for minorities and women. But why does this problem still exist? The main issue is that we don't completely understand the underlying causes of unequal prescriptions. 

Here are a few of the possible explanations that researchers have found so far: 

First, clinicians tend to misevaluate the pain of their patients. Clinicians hold stereotypes about the pain of different racial populations. They generally believe that White populations tend to experience higher amounts of pain than Black populations. However, the exact opposite is true: Black individuals have a lower pain threshold than White individuals. Similarly, clinicians tend to underestimate women's pain compared to men's for reasons unknown so far. 

Second, doctors might experience less shared pain with patients who don't belong to the same demographic group. Since most doctors in the U.S. identify as White, it can be inferred that most doctors can't empathize as easily with their non-White patients, so they tend to under-assess their pain. 

Third, patients are also affected by the race of their doctor and might not adequately communicate their pain. Research has shown that patients tend to trust their doctors more and are more satisfied with their treatment when the doctors belong to their racial group. Hispanic individuals tend to use stoicism as a coping mechanism, which can mislead clinicians to assess their pain as less intense. 

So, what can we do as patients to ensure that we will receive appropriate pain treatment? Here are a few simple steps:

  1. Know your goals before you arrive at the doctor's office. For example, do you need help with pain management, understanding the reasons underlying your pain, or both?
  2. If you can choose your medical provider, select a physician from the same racial/ethnic background as you.
  3. Try over-the-counter medication of different dosages to explore how it will affect your pain; take detailed notes about it.
  4. Communicate your goals for your visit clearly and explain which medication has worked and which hasn’t. Ask for a higher dosage than the highest ineffective dosage that you have taken.
  5. If you feel uncomfortable showing your pain with facial expressions, make a list of all the ways that the pain has interfered with your everyday life. For example, you can’t lift your bag or can’t lie on your side. Provide that information to your doctor even if you're not asked about it.
  6. If you get prescribed opioids, ask your doctor if there is a non-opioid medication that you can try first.
  7. If you are unsure that you can communicate all that information clearly, bring a partner to the appointment to assist you.  

Of course, one could argue that individual actions of patients can be proven ineffective on the treatment habits of clinicians or that encouraging patients to find treatment only by clinicians of their own race could perpetuate doctors' lack of empathy for different demographic groups. Both points are valid. These disparities will not disappear overnight and can only be extinguished by systemic changes in training and policy. 

Analgesic prescribing disparities are prevalent in the U.S., and further research is required to decipher the reasons behind them and battle them effectively. More work needs to be on clinicians' decision-making and finding ways to improve the education of future generations of physicians. 

The above suggestions can serve as a first step for us to take control of our treatment and spare ourselves from that needless shoulder pain. 

Theoni Varoudaki is a graduate student in the College of Arts and Sciences at the University of Miami. Read more about the inaugural “Op-ed Challenge.”