It seems like pain would be the great equalizer: Whether you’re black or white, we all hurt the same way.
Except, it turns out, how we're treated for it varies greatly.
Blacks and Hispanics are more likely than whites to deal with untreated pain and less likely to get adequate care for it, studies show. And minority patients who don't get proper pain treatment early on are likely to suffer depression and post-traumatic stress disorder down the road, says Dr. Carmen Green, a pain specialist and professor of anesthesiology at the University of Michigan.
Researchers don’t know whether the pain imbalance is due to caregiver bias, cultural differences, physiological variances, or a combination of factors, but they do know one thing: Pain is not colorblind.
“There is an unequal burden of pain,” Green said.
A recent study by Green of 200 chronic pain patients in the University of Michigan health system found that black patients were prescribed fewer pain medications than whites and that women were given weaker pain medications than men were given. The research published in the Journal of Pain showed that, on average, a minority pain patient would be prescribed 1.8 pain medications compared to 2.6 drugs for non-minority sufferers.
And once they do get a prescription, they have a harder time getting it filled, Green found in an earlier study, also in the Journal of Pain. Only 54 percent of pharmacies in minority neighborhoods had the most common painkillers in stock; in majority-white neighborhoods, 87 percent of pharmacies did.
Green's studies add to two decades' worth of research that shows even when pain is indisputable, such as in late-stage cancer and with broken bones, minorities get less help for their suffering.
Seven years of intense pain
That means a lot of unnecessary pain for people like Deborah Chenault-Green (no relation to Dr. Green), a black woman who suffered through seven years of intense pain before finally being diagnosed with herniated discs in her back and neck, as well as multiple sclerosis.
Chenault-Green, now 55, saw countless doctors at inner-city hospitals in her hometown of Detroit, but all they offered her were over-the-counter pain pills. She felt like the doctors weren’t taking her pain seriously — or worse, thought she was faking just to get narcotics.
“I can kind of understand where they’re coming from because they do get a lot of people who are looking for pain pills, but they kind of blanket everybody,” Chenault-Green said. “For seven years I went through doctors looking at me sideways and saying ‘Here’s a prescription for Motrin.’”
The pain got so bad she was unable to leave her house or even concentrate on anything for a long period of time. She began to question her own sanity, as doctor after doctor sent her home with no solution for the relentless pain.
“I went through depression, I went through thoughts of suicide,” Chenault-Green said. “I thought, these are the doctors, so maybe I am crazy, maybe something is wrong with me.”
Her experience is echoed by another recent study by Green showing a pronounced link between pain and depression among black men.
Things finally changed for Chenault-Green when the inner-city hospital she’d been going to stopped taking her insurance. She went to a doctor in the suburbs whom she’d seen years before. He heard her symptoms and immediately sent her to a neurologist, who ordered a CT scan and MRI, which identified the herniated discs in her back and neck (for which she had surgery in 2002). Now she’s living mostly pain-free.
“I say to this day it was by the grace of God they stopped taking my insurance,” Chenault-Green said.
Most doctors aren't trained in treating chronic pain
Racial disparities exist in all areas of health care. One reason pain is different is that there’s no test for it; the experience of pain is subjective, and the process of identifying and treating pain relies totally on the interaction between patient and doctor.
The rushed pace of modern health care may be partly to blame, said Nomita Sonty, assistant professor of anesthesiology and psychiatry at Columbia University and leader of the American Pain Society’s working group on disparities.
“With the emphasis being on getting patients in and out of clinics quickly, practitioners do not have the time to spend with those who may need just a little longer to be understood due to language, cultural and other barriers,” Sonty said.
Many doctors don’t get great training on how to identify and treat chronic pain, much less how to address racial disparities in practice, said Green, the pain specialist and University of Michigan professor.
“From a research standpoint we are probably 40 to 50 years behind in pain research” compared to other areas, Green said. “We need to address pain in a very different way.”
Some state medical licensing boards require a continuing education course on health disparities, Sonty said, and she said she would like more medical schools to include pain disparities in their core curriculum. Health-care providers are becoming aware of the problem, she said, but progress is slow.
“There has been some momentum in the direction of decreasing disparities in health care, but we still have a long ways to go,” Sonty said. “We need to establish a national agenda for addressing pain disparities.”
Green said the best thing that any pain patient can do, regardless of race, is to keep searching until they find a doctor who will listen and take their pain seriously.
“People need to realize the importance of pain,” Green said. “It saps you of your energy, your mood, your time with family and friends. But there are things that we can do. There are people who get their lives back.”
One of those people is Chenault-Green, the singer and actress is active in her community and currently directing a play at the Wayne State Arts Theater — something she could not have dreamed of a few years ago.
“I’m really doing great,” Chenault-Green said. “Back then, my focus wasn’t on anything except the pain I was in. Now my focus is on fulfilling my dreams.”