Department of Psychology, East Carolina University, Greenville, North Carolina 27858, USA.
J Pain. 2012 Jul;13(7):611-9. doi: 10.1016/j.jpain.2012.02.004. Epub 2012 May 2.
Due to high profile initiatives at the national level, awareness of inadequate pain care affecting many groups in our society has never been greater. Nevertheless, increased awareness of pain disparities and the initiatives to address these disparities have yielded only modest progress, most notably in the form of growing appreciation that pain disparities likely result from multiple factors, including biological, psychological, environmental, health system, and cultural factors. Much less progress has been made in developing interventions that target these multiple determinants to reduce pain management disparities. In this paper we discuss key ethical and methodological challenges that undermine our capacity to investigate and develop meaningful interventions to improve pain outcomes among vulnerable populations. Key challenges in the areas of research engagement, recruitment, design, and measurement are discussed from both scientific and normative standpoints. Specific opportunities within emerging research paradigms to improve designs and measures are also discussed. Finally, we conclude with identifying potential synergies between the pain management disparities research agenda and the broader areas of clinical practice, advocacy, and policy that could help to move the field forward.
Researchers studying disparities in pain care face a number of ethical and methodological challenges that must be addressed to advance the field towards eliminating disparities. We discuss these ethical and methodological challenges and propose opportunities for paradigmatic revisions in areas of research engagement, design, measurement, advocacy, and policy.
由于国家层面的高调举措，人们对影响我们社会许多群体的疼痛护理不足的认识从未如此强烈。尽管人们对疼痛差异的认识以及解决这些差异的举措有所增加，但只取得了适度的进展，最显著的是越来越认识到疼痛差异可能是由多种因素造成的，包括生物、心理、环境、医疗系统和文化因素。在制定针对这些多种决定因素的干预措施以减少疼痛管理差异方面，进展甚微。在本文中，我们讨论了关键的伦理和方法学挑战，这些挑战削弱了我们调查和制定有意义的干预措施以改善弱势群体疼痛结果的能力。从科学和规范的角度讨论了研究参与、招募、设计和测量方面的关键挑战。最后，我们确定了疼痛管理差异研究议程与临床实践、宣传和政策等更广泛领域之间的潜在协同作用，这些协同作用有助于推动该领域的发展。
研究疼痛护理差异的研究人员面临着许多必须解决的伦理和方法学挑战，才能使该领域朝着消除差异的方向前进。我们讨论了这些伦理和方法学挑战，并提出了在研究参与、设计、测量、宣传和政策等领域进行范式修订的机会。
