World of hurt: Minorities get less treatment for their pain-gctid40867

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                        World of hurt: Minorities get less treatment for their pain                    

                                              A growing body of research shows suffering is not colorblind                    

              Sarah Rice / for msnbc.com          
 
                               By Rebecca Dube
 
                    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.
 
                An X-ray shows the metal plate and screws placed in Deborah  Chenault-Green's neck to repair herniated discs. The Detroit woman spent  seven years seeking answers from doctors before being diagnosed.
 
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."

                 How to get the best pain treatment
         
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•               Dr. Nomita Sonty, of the American Pain Society, offers these tips on how patients can get the best pain treatment available:
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• Know you have the right to have your pain evaluated and treated.
• Don't wait too long. The prognosis is better when pain is evaluated sooner than later.
• When you seek care, bring any pain-related medical records you have to your appointments.
• Keep track of medications you've taken and their effects and bring this information to the appointment.
• Ask questions.
• Understand that different pain clinics have different policies and practices. If you don't find relief, try another.

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    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."

  Keep searching
   
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."