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Thread: The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain

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    The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain

    Context: Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites.

    Objectives: To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided.

    Evidence: A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication.

    Conclusions: Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities.

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    Ethnicity and Pain

    I found this amusing:

    Zborowski (1952) compared attitudes towards pain in three cultural groups from New York City by interviewing patients, doctors, nurses and other health professionals, as well as some healthy individuals from each of the cultural groups. The cultural groups were Italian-Americans, Jewish-Americans and Old-Americans.

    Italians were preoccupied with the sensation of pain and complained a great deal while they were in pain with moaning and crying, but once the pain was treated they resumed their normal activiites.

    On the other hand, Jewish patients were also very emotional when in pain and tended to exaggerate pain symptoms. However, they worried more about the effect of the pain on their health and the overall welfare of their families than about the pain itself. At times, they had difficulty resuming their normal activities because of a preoccupation with the underlying cause of their pain.

    The Old-American patients were more detached in their response to pain and they were more concerned with not bothering anyone. [. . .]

    Zborowski (1952) believed that attitudes towards pain are part of any culture's child-rearing practices. He found that both Jewish-American and Italian-American parents in his study were generally overprotective and overly concerned about their child's health and their children were frequently reminded to avoid fights, possible injuries and catching colds. Crying elicited considerable sympathy.

    However, Old-American parents were less concerned and expected that the child would not run to the parent with a small problem. Children were taught to anticipate some pain while playing and they were expected not to show excessive distress.

    [Pain. Jenny Strong, Anita M. Unruh, Anthony Wright, G. David Baxter, Patrick D. (FRW) Wall]
    (Via Mangan.)
    http://racehist.blogspot.com/2009/07...-and-pain.html

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    People I know in health care has told me the same things. Immigrants are much more fussy about pain and illness. In some instances they more or less expect an Arab or a Slav to stay an extra week or so.

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