Pain is the most common reason people access healthcare in the United States and has been identified as a major public health problem. Despite this attention, investigators have found racial and ethnic disparities in pain management. In systematic literature reviews, it has been found that African Americans are more at risk than Caucasians for experiencing under-treatment of pain (Cintron & Morrison, 2006; Ezenwa, Ameringer, Ward, & Serlin, 2006). There are also racial differences in the prevalence of pain. In a Center for Disease Control study using the 2002 National Health Interview Survey; it was found that 34% of African Americans compared to 22.6% of Caucasians with arthritis had severe pain (Bolen, Sniezek, Theis, Helmick, & et al., 2005). Consistent with the above report, there are racial differences on the impact of pain. For instance, 59.6% of African Americans compared to 30.3% of Caucasians reported pain severe enough to impact behavior (Riley & Gilbert, 2002). The overall goal of my program of research is to better understand racial disparities in pain management. As a first step toward this goal, I will explore the influence of two race-related stressors, perceived discrimination and hopelessness on disparities in pain management. Perceived discrimination is defined as chronic and routine experiences of unfair treatment. Hopelessness is a negative expectation about one's present and future life. This study will test relationships proposed in a conceptual model which suggests that the effect of race on pain outcomes (pain severity, opioid dose, satisfaction with pain treatment, and quality of life) is mediated by perceived discrimination and hopelessness.
The specific aims of this study are (1) to examine the relationship between race and pain outcomes and (2) to test whether perceived discrimination and hopelessness mediate the relationship between race and pain outcomes. This study will be a secondary analysis of data from a large cross-sectional survey of patients with chronic noncancer pain. Understanding the role of perceived discrimination and hopelessness on disparities in pain management may be useful in the future design of culturally appropriate pain management educational interventions for African Americans and culturally sensitive educational interventions for healthcare providers. This study will help reduce the public health problems that arise from poorly treated pain (e.g., unnecessary suffering, delayed healing, and lengthened hospitalization). ? ? ?
| Ezenwa, Miriam O; Fleming, Michael F (2012) Racial Disparities in Pain Management in Primary Care. J Health Dispar Res Pract 5:12-26 |
| Krause, Melanie R; Serlin, Ronald C; Ward, Sandra E et al. (2010) Testing mediation in nursing research: beyond Baron and Kenny. Nurs Res 59:288-94 |
