Chronic pain patients younger than age 50 may be less able to cope with pain and more prone to pain-associated sequelae including depression, compared with their older counterparts, a new study suggests. However, African Americans of all ages experience more pain and more pain-related negative effects than do caucasians, according to the new research, published in a special issue of the journal Pain Medicine that addresses race issues in pain management.

"This study really clarifies that racial and ethnic minorities have a different experience with pain, but younger individuals have more difficulty with pain and that's key," study author Carmen R. Green, MD, of the University of Michigan Health System's Department of Anesthesiology in Ann Arbor, tells CIAOMed. "All patients are at risk of pain sequealae, but African Americans and younger individuals tend to have more problems."

"There are huge differences between races and within race based upon age," says Dr. Green, who was recently named an inaugural Mayday Pain and Society Fellow by the Mayday Pain Project, a New York City-based foundation aimed at alleviating the incidence, degree, and consequence of pain.

The significant differences between the age groups existed within both racial groups in the study. Older caucasians and African Americans were better able to cope with their pain, had less trouble falling asleep, and had fewer depressive symptoms than their younger counterparts, the study showed.

Those who develop chronic pain at an early age may have more difficulty enduring it than those who develop pain later in life, according to Dr. Green. "Older people have had more experiences, including experience with wars, that allow them to cope with pain, [whereas] younger people may not have had this experience, or they may have different types of pain complaints," she suggests.

Overall, African Americans of all ages scored higher than caucasians on measurements of the intensity of pain, disability related to pain, and depression symptoms. The findings held even after the researchers controlled for differences in the duration of pain, gender, marital status, and education. African Americans are also more likely than caucasians to have several chronic illnesses including diabetes and arthritis; they are more likely to experience increased disability associated with those diseases and to be undertreated for pain across a range of conditions.

The retrospective, cross-sectional investigation led by Dr. Green examined data of 5823 African American and caucasian adults presenting for chronic pain management at the University of Michigan Multidisciplinary Pain Center over 8 years. Within the two racial groups, study participants were divided into two age groups: those under and those over age 50 years. During evaluation, participants completed several widely used questionnaires that assess mental and physical status, including the McGill Pain Inventory, the Pain Rating Index, Pain Disability Index, and the Beck Depression Inventory.

Exactly why the racial disparities exist is multifold, Dr. Green says. "Provider variability has been cited over and over again by several authors," she notes, referring to the differences in how health care providers make decisions about pain management.

Moreover, Dr. Green points out, certain patients cannot obtain adequate pain medication in their local communities, perhaps due to the fact that pharmacies in neighborhoods with large minority populations tend not to carry narcotic analgesics.

"The bottom line is that physicians need to assess the impact that pain has on quality-of-life, Dr. Green tells CIAOMed. "The history and physical exam is fairly fluid, but we may need to listen more to see the impact that pain has on life and recognize that racial and age disparities may exist."

Noting that C ongress has mandated 2000 through 2010 as the Decade of Pain Control and Research, Dr. Green comments that "we are at the halfway mark of the decade. Now we are raising the bar and expecting people to assess for pain, so there has been an improvement. Yet, so many patients suffer needlessly due to pain -- and racial and ethnic minorities who suffer are more at risk for inadequate treatment."

The editor of Pain Medicine, Rollin M. Gallagher, MD, MPH, concurs with Dr. Green's assessment. "Physicians should learn early on about the impact of ethnicity, culture, and race on pain so they can use information in the clinical decision-making process to better their outcome," says Dr. Gallagher, who is director of pain medicine at the Philadelphia VA Medical Center in Pennsylvania and a clinical professor of psychiatry and anesthesiology at the University of Pennsylvania, also in Philadelphia.

Understanding ethnic disparities in pain treatment "is critically important ... because chronic pain as a disease process has a major catastrophic influence on peoples' lives," Dr. Gallagher points out.

Commenting on the new study's findings that age-related differences are common to both groups, he also observes that "this is a test of the hypothesis that patients learn coping skills over time...If you have a young patient in the office, you have to help him or her acquire those coping skills," he tells CIAOMed. "You just can't assume that they already have them."

Reference:

Baker TA, Green CR. Intrarace Differences Among Black and White Americans Presenting for Chronic Pain Management: The Influence of Age, Physical Health and Psychosocial Factors. Pain Med. 2005;6:29-38.