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Science in Action
Pain Management

The Cost of Pain

Pain is generally under-treated in the U.S., but low-income and minority patients are even less likely to receive guideline-recommended pain treatment in virtually all healthcare settings in the U.S., according to the authors of a new paper from the University of Pennsylvania School of Nursing, even though minority patients often suffer more severe pain and physical impairments than non-minority patients and are more likely to perform potentially harmful physical work.

In “Pain Medicine, the Official Journal of the American Academy of Pain Medicine,” the reviewers recommended:
  • Creating public education programs not only for chronic pain but for educating the public about disparities
  • Instituting public health marketing campaigns for pain disparities,
  • Urging pain advocacy groups to unite on issues of common interest, such as disparities in pain care
  • Setting quality assurance standards for pain treatment through the Centers for Medicare and Medicaid Services or National Quality Forum, and
  • Including measures of disparities as part of the Pain and Policy Studies Group statewide pain report cards
Poor and minority patients often experience pain for many years before being seen by a specialist in pain treatment, possibly because health providers are more likely to under-assess pain in minorities. Further, minority and low-income patients are more likely to live in geographic areas that constrain their access to healthcare.  Pharmacies in predominantly minority zip codes are significantly less likely to have sufficient supplies of pain medications than pharmacies in predominantly white zip codes, the reviewers found.
“There is no question that pain treatment disparities matter in many significant ways; the most important are the tremendous burdens placed on patients, health systems, and society when the most effective pain care is not accessible, affordable, and delivered to those in need,” said Penn Nursing professor and lead author Salimah Meghani, PhD, RN. “Until the prevailing issues of inequitable healthcare are realized and confronted through focused and systematic strategies for education, research, and healthcare reform, it is unlikely that progress will occur in reducing and ultimately eliminating pain disparities.”
According to recent estimates, chronic pain affects 116 million American adults and it remains the number one reason people seek medical care. The burden of pain on Americans in direct and indirect costs can reach $635 billion annually. This expenditure includes disability, poor quality of life, relational problems, lost income and productivity, and higher health care utilization including longer hospital stays, emergency room visits, and unplanned clinic visits.
The report, "Advancing a National Agenda to Eliminate Disparities in Pain Care: Directions for Health Policy, Education, Practice, and Research," informs the recent Institute of Medicine report “Relieving Pain in America” which identifies opportunities for improving pain care in the United States.  
While the actual cost of pain treatment disparities in the U.S. has not been quantified, Dr.Meghani and colleagues anticipate this cost to be large given the magnitude of pain under-treatment among minorities and underserved. 

Dr. Meghani and colleagues, including Penn Nursing professor Rosemary Polomano, PhD, RN, FAAN, also proposed broad advocacy initiatives such as “Look at the Data Campaigns©,” especially targeted at providers to sensitize them to their blind spots that contribute to inequitable pain care, emphasizing the need for targeted education in pain disparities as part of graduate and continuing medical education, as well as in licensure, accreditation, and certification programs for medicine, nursing, and allied health professionals.

While the Patient Protection and Affordable Care Act mandates federally funded programs to consistently collect data to track trends in healthcare disparities, the authors urged the creation of public-private partnerships in promoting standardized reporting of race and ethnicity data to allow researchers to track disparities, monitor efforts to reduce them, and compare findings across studies regardless of the source of funding.