Chen Ian, Kurz James, Pasanen Mark, Faselis Charles, Panda Mukta, Staton Lisa J, O'Rorke Jane, Menon Madhusudan, Genao Inginia, Wood JoAnn, Mechaber Alex J, Rosenberg Eric, Carey Tim, Calleson Diane, Cykert Sam
Eastern Virginia Medical School, Norfolk, USA.
J Gen Intern Med. 2005 Jul;20(7):593-8. doi: 10.1111/j.1525-1497.2005.0106.x.
Chronic pain is a frequent cause of suffering and disability that negatively affects patients' quality of life. There is growing evidence that disparities in the treatment of pain occur because of differences in race.
To determine whether race plays a role in treatment decisions involving patients with chronic nonmalignant pain in a primary care population.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey was administered to patients with chronic nonmalignant pain and their treating physicians at 12 academic medical centers. We enrolled 463 patients with nonmalignant pain persisting for more than 3 consecutive months and the primary care physicians participating in their care.
Analysis of the 397 black and white patients showed that blacks had significantly higher pain scores (6.7 on a scale of 0 to 10, 95% confidence interval (CI) 6.4 to 7.0) compared with whites (5.6, 95% CI 5.3 to 5.9); however, white patients were more likely to be taking opioid analgesics compared with blacks (45.7% vs 32.2%, P<.006). Even after controlling for potentially confounding variables, white patients were significantly more likely (odds ratio (OR) 2.67, 95% CI 1.71 to 4.15) to be taking opioid analgesics than black patients. There were no differences by race in the use of other treatment modalities such as physical therapy and nonsteroidal anti-inflammatories or in the use of specialty referral.
Equal treatment by race occurs in nonopioid-related therapies, but white patients are more likely than black patients to be treated with opioids. Further studies are needed to better explain this racial difference and define its effect on patient outcomes.
慢性疼痛是导致痛苦和残疾的常见原因，会对患者的生活质量产生负面影响。越来越多的证据表明，由于种族差异，疼痛治疗存在差异。
确定种族在基层医疗人群中慢性非恶性疼痛患者的治疗决策中是否起作用。
设计、地点和参与者：对12个学术医疗中心的慢性非恶性疼痛患者及其治疗医生进行了横断面调查。我们纳入了463例非恶性疼痛持续超过3个月的患者以及参与其治疗的基层医疗医生。
对397例黑人和白人患者的分析表明，黑人的疼痛评分（0至10分制，平均为6.7分，95%置信区间[CI]为6.4至7.0）显著高于白人（5.6分，95%CI为5.3至5.9）；然而，与黑人相比，白人患者更有可能服用阿片类镇痛药（45.7%对32.2%，P<0.006）。即使在控制了潜在的混杂变量后，白人患者服用阿片类镇痛药的可能性仍显著高于黑人患者（优势比[OR]为2.67，95%CI为1.71至4.15）。在使用其他治疗方式（如物理治疗和非甾体抗炎药）或专科转诊方面，种族之间没有差异。
在非阿片类相关治疗中，种族间的治疗是平等的，但白人患者比黑人患者更有可能接受阿片类药物治疗。需要进一步研究以更好地解释这种种族差异并确定其对患者预后的影响。
