Everyone should receive the same high quality of health care. Unfortunately, we know this is too often not the case.
Disparities in health care affect a wide range of people who need medical help, but this is especially true for people with chronic pain, who tend to face challenges just convincing doctors that their pain is real.
Here’s how disparities in health care affect people with chronic pain.
Pain care and racism
In a special health care disparities issue of the INvisible Project, U.S. Pain’s magazine, Courtney S. White, MD, a headache medicine fellow at the Jefferson Headache Center in Philadelphia, shared how many of her peers are ill-informed when it comes to disparities.
“Even today a lot of medical professionals think that Black and Latinx patients do not feel pain the same way that white people do,” White said.
One study shockingly found that half of white medical students believed at least one false statement like “Black people’s nerve-endings are less sensitive than white people’s nerve-endings” to be true. And when it comes to treatment, things don’t get much better.
Take, for example, this tweet from Dr. Vanila Singh, the Former U.S. Chief Medical Officer and the U.S. Department of Health & Human Services chair of the Pain Task Force.
These disparities speak to the overwhelming bias of doctors and, oftentimes, the lack of diversity among the ranks of medical professionals.
According to the Association of American Medical Colleges, “Among active physicians, 56.2% identified as White, 17.1% identified as Asian, 5.8% identified as Hispanic, and 5.0% identified as Black or African American.”
Needless to say, it is concerning that a diverse patient population will at least 50% of the time meet with a physician who is white and likely has a different background.
Disparities in LGBTQ+ care
Sexual identity can also, unfortunately, lead to disparities in health care. As the Office of Disease Prevention and Health Promotion notes, “Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBT persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide.”
People with chronic pain have at least twice the risk of suicide than those without chronic pain, so these societal stressors forced upon members of the LGBTQ+ communities make managing and coping with chronic pain all the more difficult.
One study found that “among females, sexual minorities reported more suicidal ideation and depressive symptoms than completely heterosexuals, and sexual orientation disparities in pain among females were partially explained by mediators that included suicidal ideation, suicide attempt, and depressive symptoms.”
Another study that examined disparities in chronic conditions and health indicators among lesbian, gay, and bisexual (LGB) adults 50 years or older in the U.S. found that “LGB adults were significantly more likely than heterosexual older adults to have a weakened immune system and low back or neck pain.”
In addition, the paper noted that “At substantial cost to society, many disparities in chronic conditions, disability, and mental distress observed in younger LGB adults persist,” and made the recommendation that drastic steps be taken immediately to address these disparities.
For transgender individuals, studies also paint a discouraging picture, noting that they “have higher observed rates of potentially disabling mental health and neurological/chronic pain conditions.”
In an article published in the disparities edition of the INvisible Project, disability activist and YouTube star Annie Segarra summed up the experience of many LGBTQ+ individuals with chronic pain face when seeking health care.
“Patients come to doctors when they are at their most vulnerable; in pain, scared, and struggling, often spending immense savings just to get into their offices, only for them to be dismissed, disrespected, and made to feel hopeless,” Segarra said.
Imagine walking into a doctor’s office and being unable to communicate with the staff and healthcare professionals. While options do exist for translation, the lag these technologies create can be discouraging, especially for those with chronic pain who already have trouble communicating with doctors.
In a recent blog post, we outlined some of these issues and how they impact patients. The simple fact is that not all hospital systems have the technology or processes in place to meet the needs of non-English speakers.
In an op-ed in the LA Times, physician Mimi Zheng shared an all-too-common occurrence, writing:
“A Korean American resident I know told me that he was once asked by his attending physician to have a conversation with a patient in Korean; he found himself struggling to discuss a cancer diagnosis using his first-grade-level knowledge of the language. On another occasion, my attending physician misunderstood a Spanish-speaking woman and thought she was complaining of chest pain; the doctor ordered several unnecessary tests to rule out a heart attack.”
Solutions exist, but if they are not widely put in place or made available to practices of all sides, these issues will continue.
A lack of options
A further issue is the availability of pain care options for people across the country. According to the CDC, the percentage of adults with chronic pain and high-impact chronic pain increase as place of residence becomes more rural.
Unfortunately, clinics and specialists who can treat people with chronic pain decreases, forcing many to travel hours just to receive needed medical attention—if they can travel at all. The recent wider acceptance and usage of telemedicine has the potential to lessen some of this load, but still not a perfect solution as rural communities might lack the necessary internet speeds and there is just no replacement for seeing a health care practitioner in person.
The data gap and next steps
Another critical issue facing pain management and health care in America is a simple one—we just don’t know enough about the people who need care.
According to the National Institute on Minority Health and Health Disparities (NIMHD), “Though Hispanic Americans are the fastest growing ethnic group in the United States, much less is known about their pain experience—including potential disparities in pain treatment—than for other racial or ethnic minorities.”
So, what needs to be done to address these many issues?
To begin with, there needs to be an increased focus on collecting population health data among ethnic groups and by location.
Physicians and health care providers need to be exposed to this accumulated data while having regular training to disabuse them of some of these incorrect beliefs around ethnicity.
Pre-med students should be required to take courses on diversity and health disparities, while universities should continue to make more effort to reach out to students from diverse backgrounds. Several universities offer minors and programs focusing on health disparities, but it is not as widespread as it should be.
There should also be a greater focus on health disparities in medical school and exposing future doctors to populations with different backgrounds than themselves.
Perhaps most importantly, there needs to be greater empathy and understanding for people with chronic pain across the board. Health disparities and inequality in health care is a critical issue that needs to be addressed now.