Pubdate: Tue, 15 Mar 2005 Source: Asbury Park Press (NJ) Copyright: 2005 Asbury Park Press Contact: http://www.app.com/ Details: http://www.mapinc.org/media/26 Author: Sheri Hall, Gannett News Service Bookmark: http://www.mapinc.org/find?232 (Chronic Pain) THE PAIN GAP Minorities In America Are Considered "Under Treated" For Their Pain From Medical Conditions Donald Dillard counted himself lucky to survive when a loaded dump truck rolled over his body, crushing his pelvis and thighs and shredding a football-size chunk of flesh in his torso. But the 15 years since have been a nightmare of agonizing days and nights made worse by the lack of potent pain medications at pharmacies near his home, struggles to get proper care and the red tape involved in workers' compensation coverage. "It's really depressing when you know there are things out there that can help you, and you can't get them," said Dillard, who lives in Detroit. Dillard's problems illustrate a pervasive inequity in our nation's health care system: Hispanics and African Americans are consistently under-treated for pain across a range of conditions, from cancer to chest pain to broken bones. As pain management emerges as a medical specialty, a mounting body of evidence shows minorities are less likely than whites to receive medicines, physical therapy and care they need. The impact of chronic pain can be devastating, sapping quality of life, interrupting sleep and eating patterns, and triggering depression. Chronic pain can even prevent some from working. "There is no question that this is an issue," said Dr. Peter S. Staats, a board-certified and fellowship-trained pain management physician at Riverview Medical Center, Red Bank. "There are many people not getting treatment for their chronic pain, and race is part of the equation." Just as important, Staats added, is that pain management is not fully recognized as a board specialty by the American Board of Medical Specialties. "But there are a group of like-minded doctors who recognize that there is disease of chronic pain," said Staats, who serves on the board of directors of the American Academy of Pain Medicine. "Chronic pain affects a person in so many different ways -- physical, psychological, emotional. "Pain is a leading cause of disability and a major health care crisis in the United States," Staats pointed out. "The good news is that people living with pain simply do not have to struggle with their pain every day. We have many new minimally invasive approaches that can help a large percentage of patients with chronic or acute pain." Ingrained Racial Stereotypes Getting that treatment, though, can sometimes prove problematic. Many experts say disparate treatment can be traced to deep-seated racial stereotypes, such as the assumption that minorities are more likely to abuse or sell potent drugs or the archaic belief they don't feel pain as acutely as whites. Economic factors play a large role as well. In 2002 and 2003, nearly 60 percent of Hispanics and more than 40 percent of African Americans nationwide were without health insurance, cutting them off from proper treatment. And pharmacies in low-income minority neighborhoods are less likely to carry strong pain medicines. The issue of pain treatment fits into a troubling overall health picture for minorities. A federal study in 2002 found minorities generally receive lower-quality health care than white patients, even when their income, insurance and medical conditions are similar. For Dillard, it was only when a University of Michigan pain specialist took up his cause that life started to improve. "Looking back, I can see how I used to be withdrawn and disgruntled with the way things were," he said. "Slowly but surely, I'm doing more. It's a long, hard process." It's A New Field Uncontrolled pain is a growing problem that straddles racial lines. More than 50 million Americans suffer from chronic pain, costing more than $100 billion in reduced productivity, sick time and medical costs, estimates the American Chronic Pain Association and the National Institutes of Health. Diagnosing the pain isn't always easy, either. "I can look at two similar MRIs and not be able to say which person has more pain," Staats said. "With chronic pain, what needs to be done is a complete family history and a physical examination before coming up with a therapeutic strategy." And with the endless numbers of pain treatment options available, from over-the-counter remedies, to physical therapy to surgical procedures, it can be difficult for patients to know what is best to treat their symptoms, Staats said. "Many people are unaware that there is a whole discipline of pain management," said Staats, the former chief of Pain Medicine at Johns Hopkins University Medical School, Baltimore. "They don't know that there are people who are specially trained to deal with the kinds of pain they are facing . . . and that they don't just have to live with the pain." Pain management is a relatively new field, not even taught in medical schools until the 1990s. Even now, Staats said, many medical schools only provide two hours of training for students. Dozens of studies have found that African Americans and Hispanics receive less pain treatment than the general population. Personal Biases A Factor A 2003 study found that African Americans who sought treatment at a Michigan pain clinic reported significantly more pain and distress. Another national study found that whites who came to hospital emergency rooms with broken legs were twice as likely to get pain medication as Hispanic patients. "You can't get into the heads of individual physicians to see what they're thinking, but, on the whole, it's clear they're not managing pain as aggressively in minority populations," said Gary A. Puckrein, president of the National Minority Health Month Foundation. The root of the issue, many doctors say, is personal biases in the treatment of patients -- especially people complaining of severe pain. "It's a tough situation because when someone comes in complaining of severe pain, you don't know how they feel," said Dr. Felix Valbuena, medical director of the Community Health and Social Services clinic in southwest Detroit, which primarily serves Hispanic patients. That's where stereotypes come into play, such as the mistaken belief that African Americans have a higher threshold to tolerate pain, said Dr. Winston Price, president of the National Medical Association, which represents African American doctors. It's also discriminatory and wrong to assume that minorities are more likely to abuse painkillers or sell them on the street, experts say. "There's no scientific basis for that," Price said. "But the bias, whether overt or covert, is to under medicate African Americans." Fear Is Another Factor Beyond judging patients, doctors face the risk of federal investigation for prescribing large amounts of painkillers. Last year, the U.S. Drug Enforcement Agency said doctors could be investigated based on how many of their patients get narcotics, the number of pills patients receive and how long they stay on the drugs. "There's a very small number of physicians who get prosecuted, but when it happens, it certainly catches everyone's attention," said Dr. Jeffery Kimpson, a pain specialist at Providence Hospital in Southfield, Mich. "There are barriers built into the system to make you a little more hesitant to prescribe." Even when minority patients find a pain specialist to work with, they're often denied the drugs they need because pharmacies in minority neighborhoods are less likely to carry potent painkillers. Some pharmacists say they're deterred from stocking heavy-duty painkillers because of the danger of robberies and opportunity for abuse. A string of high-profile killings in 2000 and 2001 spurred some drugstore chains to stop stocking OxyContin. Others say there isn't sufficient demand. "We have been broken into, and that is a factor," said Mary Frazier, owner and pharmacist at M&D Pharmacy in Detroit, which carries Vicodin but not OxyContin or any immediate-release morphine products. "But we really don't have much demand, and if we get phone calls, we will send them to another pharmacy that carries what they need." The most common fear of patients in pain is that they'll become addicted to narcotics, pain experts say. Some patients confuse addiction with tolerance. Fear is an excuse heard often by Linda Vanni, the pain specialist at Barbara Ann Karmanos Cancer Institute in Detroit. "I ask them right out front, "What are you afraid of?' " she said. "Sometimes it's "I'm afraid to take my medicine home because someone in my family will take it.' Sometimes, they're afraid of the side effects. "A lot of people believe that if you suffer here, you pave your way to heaven." - --- MAP posted-by: Derek