The influence of undertreated chronic pain in a national survey: Prescription medication misuse among American indians, Asian Pacific Islanders, Blacks, Hispanics and whites

Michelle Johnson-Jennings, Bonnie Duran, Jahn Hakes, Alexandra Paffrath, Meg M. Little

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Abstract

Objective: Disparities in the assessment and treatment of chronic pain among racial/ethnic may lead to self-treatment for undertreated pain. This study examines whether pain intensity among US racial/ethnic groups’ influences rates of psychotherapeutic prescription drug misuse. Methods: Data included civilian, non-institutionalized adults (age 18–99 years) residing in the United States (n = 34,653) from Waves 1 and 2 of the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC; 2004–2005). The primary outcome variable was prescription drug misuse/PDM (i.e., use without a prescription or other than as prescribed) including tranquilizers, sedatives, stimulants, or opioids. Predictor variables included self-reported race/ethnicity (American Indian, Black, Hispanic, or White) and pain intensity. Data were analyzed in 2019. Results: Overall, White and Hispanic participants’ pain intensity had a significantly curvilinear relationship with frequency of prescription medication (p < 0.01). PDM rose with pain intensity until pain levels reached “severe,” then PDM rates fell, not significantly differing from the “no pain” levels (χ2(1) = 0.65, p = 0.42). PDM rates for Black participants remained lowest of all other racial/ethnic groups and plateaued with increasing pain intensity. Conclusions: Our results indicate that undertreated chronic pain may drive rates of PDM among varying racial/ethnic groups. Providing equitable assessment and treatment of pain intensity remains critical. Additional research is needed to examine provider decision-making and unconscious bias, as well as patient health beliefs surrounding perceived need for prescription pain medications.

Original languageEnglish (US)
Article number100563
JournalSSM - Population Health
Volume11
DOIs
StatePublished - Aug 2020

Bibliographical note

Funding Information:
White operated as the reference group in order to estimate racial/ethnic pain care disparities (Anderson, Green, & Payne, 2009; Green et al., 2003; Jimenez, Garroutte, Kundu, Morales, & Buchwald, 2011). Pain level intensity was measured by the question: during the past 4 weeks, how often did pain interfere with normal work including both work outside the home and housework? Please answer on a five-point scale (1 = not at all; 5 = extremely) to constitute an individual need factor (i.e., a person's perceived need for health services). In Andersen's health behavior model (Andersen & Davidson, 2001) individual predisposing factors include race/ethnicity, age, sex, and education. Enabling factors included family income and health insurance coverage. We retained the values assigned and allocated by NIAAA to replace missing values (see NESARC Source and Accuracy Statements) (Grant & Kaplan, 2005; Grant, Moore, Shepard, & Kaplan, 2003). The descriptive characteristics for all five racial/ethnic groups are reported in Table 1.This work was supported by the following: NIH grants 5R25MH084565-03; 5R25MH084565-03; 5R01DA034466 02 We would also like to acknowledge Dr. Mustafa al'Absi who gave feedback during the earlier drafts of this manuscript and offered support. Dr. Jahn Hakes, from the U.S. Census Bureau Center for Economic Studies, had access to the complete data and assumed responsibility for the data analysis. Any opinions and conclusions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Census Bureau or the NIAAA. All results have been reviewed to ensure that no confidential information is disclosed. The statistical summaries reported in this document have been cleared by the Census Bureau's Disclosure Review Board release authorization number CBDRB-FY19-124.

Funding Information:
This work was supported by the following: NIH grants 5R25MH084565-03 ; 5R25MH084565-03 ; 5R01DA034466 02 We would also like to acknowledge Dr. Mustafa al’Absi who gave feedback during the earlier drafts of this manuscript and offered support. Dr. Jahn Hakes, from the U.S. Census Bureau Center for Economic Studies, had access to the complete data and assumed responsibility for the data analysis. Any opinions and conclusions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Census Bureau or the NIAAA. All results have been reviewed to ensure that no confidential information is disclosed. The statistical summaries reported in this document have been cleared by the Census Bureau's Disclosure Review Board release authorization number CBDRB-FY19-124.

Publisher Copyright:
© 2020 The Authors

Keywords

  • Chronic non cancer pain
  • Prescription drug misuse
  • US racial/Ethnic groups
  • Under treated pain

PubMed: MeSH publication types

  • Journal Article

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