Atkins Nicole, Mukhida Karim
Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Can J Pain. 2022 Sep 1;6(1):142-170. doi: 10.1080/24740527.2022.2104699. eCollection 2022.
Though chronic pain is widespread, affecting about one-fifth of the world's population, its impacts are disproportionately felt across the population according to socioeconomic determinants such as education and income. These factors also influence patients' access to treatment, including pharmacological pain management.
A scoping review was undertaken to better understand the association of socioeconomic factors with physicians' pain management prescribing patterns for adults living with chronic pain.
An electronic literature search was conducted using the EMBASE, CINAHL, SCOPUS, and Ovid MEDLINE databases and 31 retrieved articles deemed relevant for analyses were critically appraised.
The available evidence indicates that patients' lower socioeconomic status is associated with a greater likelihood of being prescribed opioids to manage their chronic pain and a decreased likelihood of receiving prescription medications to manage migraines, rheumatoid arthritis, and osteoarthritis.
These results suggest that individuals with lower socioeconomic status do not receive equal prescription medicine opportunities to manage their chronic pain conditions. This is influenced by a variety of intersecting variables, including access to care, the potential unaffordability of certain therapies, patients' health literacy, and prescribing biases. Future research is needed to identify interventions to improve equity of access to therapies for patients with chronic pain living in lower socioeconomic situations as well as to explain the mechanism through which socioeconomic status affects chronic pain treatment choices by health care providers.
SES: socioeconomic status; RA: rheumatoid arthritis; IV: intravenous; SC: subcutaneous; bDMARDs: biological disease-modifying antirheumatic drugs; DMARDS; disease-modifying antirheumatic drugs; TNFi: tumour necrosis factor inhibitors; NSAIDs: non-steroidal anti-inflammatory drugs.
尽管慢性疼痛普遍存在，影响着全球约五分之一的人口，但根据教育和收入等社会经济决定因素，不同人群所受的影响程度并不均衡。这些因素还会影响患者获得治疗的机会，包括药物性疼痛管理。
进行一项范围综述，以更好地了解社会经济因素与医生对慢性疼痛成年患者的疼痛管理处方模式之间的关联。
使用EMBASE、CINAHL、SCOPUS和Ovid MEDLINE数据库进行电子文献检索，并对检索到的31篇被认为与分析相关的文章进行严格评估。
现有证据表明，社会经济地位较低的患者更有可能被开具阿片类药物来管理慢性疼痛，而接受偏头痛、类风湿性关节炎和骨关节炎处方药治疗的可能性较低。
这些结果表明，社会经济地位较低的个体在管理慢性疼痛疾病时无法获得平等的处方药机会。这受到多种相互交织的变量影响，包括获得医疗服务的机会、某些治疗可能无法负担、患者的健康素养以及处方偏见。未来需要开展研究，以确定改善社会经济地位较低的慢性疼痛患者获得治疗机会公平性的干预措施，并解释社会经济地位影响医疗服务提供者慢性疼痛治疗选择的机制。
SES：社会经济地位；RA：类风湿性关节炎；IV：静脉注射；SC：皮下注射；bDMARDs：生物性改善病情抗风湿药；DMARDs：改善病情抗风湿药；TNFi：肿瘤坏死因子抑制剂；NSAIDs：非甾体抗炎药
