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."
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