PMC Statement on Racial Injustice
The Pain Management Collaboratory (PMC) is saddened and angered by the brutal deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery. At this time, when the nation is confronting the legacy of racism and its devastating impact on the lives of African Americans, the Pain Management Collaboratory wants to call attention to how racism contributes to the greater burden of pain experienced by African Americans and other non-White Groups. African Americans and Latinx have greater pain severity and African Americans have more pain-related disability than non-Latinx Whites. African Americans also experience racial disparities in pain assessment and treatment. African Americans are less likely than whites to be treated with opioid analgesics (see review by Meghani, 2012), and African Americans are more likely than whites to be referred to urine drug tests and substance abuse specialists & denied early prescription renewals (Meints, 2019).
There is evidence that healthcare providers contribute to racial disparities in pain, through racial biases in pain assessment and treatment. African American patients stereotyped as more likely to become addicted, more likely to misuse opioids. African American patients also have poorer quality interactions with their healthcare providers than white patients, which can adversely affect treatment and healthcare outcomes. There is also mounting evidence that racial discrimination contributes to pain among African Americans and other non-White groups.
Major lifetime discrimination was strongest predictor of back pain among African Americans (Edwards, 2008) and everyday discrimination was associated with chronic pain conditions among Asian Americans (Gee, 2007). Among older African American Veterans, lifetime experiences of discrimination were associated with greater bodily pain, even after controlling for socioeconomic and health-related characteristics (Burgess, 2009). Racial discrimination has also been associated with greater pain in African Americans with sickle cell disease (Haywood, 2014; Mathur, 2016) and among African American women with osteoarthritis (Taylor, 2018). African Americans and other non-White Americans also face myriad barriers to accessing high quality pain care as well as non-pharmacological treatment for pain.
The PMC is committed to addressing such barriers to high quality pain care for African Americans and other racial and ethnic minority groups as we conduct and disseminate our research. We are committed to overcoming the legacy of African Americans being excluded from clinical trials, and believe that our use of Pragmatic Clinical Trials will help us to promote diversity and inclusion, in support of the ethical principle of justice. As we conduct our trials during the COVID-19 pandemic, which disproportionately affects African Americans, we will make concerted efforts to utilize and make available telemedicine and remote platforms to enable all racial/ethnic minority groups to safely participate. We will also work with policy-makers to help ensure that African Americans and other racial/ethnic minority group members are able to access and benefit from our non-pharmacological treatment interventions for chronic pain.
Diana Burgess, PhD, on Racial Disparities in Health Care
Diana Burgess, Ph.D., is the principal investigator for the Learning to Apply Mindfulness to Pain (LAMP) trial, one of the 11 PMC’s Pragmatic Clinical Trials. Dr. Burgess is a social psychologist. Her current research focuses on non-pharmacological treatment for chronic pain, with an emphasis on marginalized groups (women and African Americans).