Opioid Safety: Balancing Benefits and Risks ______________________________________________________
especially widespread, from prevalent misperceptions (often unconscious) that this group has higher pain tolerance and is more likely to abuse their opioid prescription [25]. As a result, prescribers, dispensers, and administrators would benefit from considering both the tenets of appropriate opioid prescribing and the impact of culture on experiences of pain and effective pain management. It is clear that health disparities exist among racial and ethnic minority groups, and this is true for pain management services and medications. A large-scale national study in the United States found racial differences in the prescription of analgesics for patients with migraine, low back pain, and bone fractures [26]. Specifically, Black Americans were less likely to be pre- scribed analgesics for their pain compared with their White counterparts. Racial minority patients are also more likely to experience longer wait times for medication compared with White patients [27]. Analysis of a national dataset found that Black Americans were less likely to be prescribed opioids for back pain and abdomi- nal pain compared with non-Hispanic White Americans [28]. The authors speculate that racial biases may influence prescribing behaviors. An examination of Medicaid patients who received epidural analgesia during vaginal childbirth also found statistically significant racial/ethnic differences [29]. In this study, 59.6% of the White patients received epidural analgesia, compared with 49.5% of Black Americans, 48.2% of Asians, and 35.2% of Hispanics. Even after the researchers controlled for age, urban/rural residence, and the availability of anesthesiologists, race and ethnicity still predicted epidural analgesia prescribing trends [29]. In a meta-analysis of ethnicity and pain management research- ers found that professionals under-rated ethnic minority patients’ levels of pain and were less likely to indicate their pain scores on their charts compared with their White counterparts [30]. In addition, Black American and Hispanic patients were less likely to have been given analgesics than White patients. Studies have not definitively isolated the factors that contribute to these disparities. One of the challenges in understanding health disparities, and particularly pain management dis- parities, is the fact that racial and ethnic minority groups are heterogeneous [31; 32]. Healthcare professional barriers may include professionals’ beliefs about appropriate pain manage- ment; lack of training and knowledge about the intersection of pain and culture, race, and ethnicity; lack of culturally sensitive assessment for pain; and expectations about racial and ethnic minority pain patients based on stereotypes [33]. Consequently, practitioners may underestimate and minimize racial minority patients’ pain experiences. In a qualitative study, Native American individuals described their complaints of pain being dismissed, receiving inadequate care, and neglected aftercare [34]. Studies have also shown that the language and race/ethnicity of the healthcare professional influences pain management. For example, the ratings of pain tend to be comparable when
the patient and healthcare provider speak the same language. When there is a native language, pain ratings tend to diverge. When literacy and language barriers are eliminated, assessment and treatment improve and racial and ethnic minority patients with pain fare better [35]. In addition, healthcare profession- als’ level of empathy appears to increase when the patient and healthcare professional share the same skin color or are of the same ethnic group [36; 37]. It is important to note that disparities in pain management are not typically intentional. Instead, they are the result of a myriad of issues, including healthcare system, socioeconomic, and cul- tural factors. However, prescriber and dispenser unconscious bias can contribute to the undertreatment of pain in certain groups. Promoting positive emotions such as empathy and compassion can help reduce implicit biases. This can involve strategies like perspective taking and role playing [38]. In a study examining analgesic prescription disparities, nurses were shown photos of White or Black American patients exhibiting pain and were asked to recommend how much pain medication was needed; a control group was not shown photos. Those who were shown images of patients in pain displayed no differences in recommended dosage along racial lines; however, those who did not see the images averaged higher recommended dosages for White patients compared with Black patients [39]. This sug- gests that professionals’ level of empathy (enhanced by seeing the patient in pain) affected prescription recommendations. CONCLUSION Opioid analgesics are approved by the FDA for the treatment of moderate or severe pain. However, individual patients dif- fer greatly in clinical response to different opioid analgesics, and patient populations show widely variable response to the same opioid and dose. These response variations make opioid prescribing challenging. Further, the important role of opioid analgesics is broadly accepted in acute pain, cancer pain, and palliative and end-of-life care, but it is controversial for the management of chronic noncancer pain. Previous opioid prescribing guidelines have been criticized for lacking a patient- centered approach and failing to emphasize individualization of therapy. This prompted the 2022 revision of the CDC’s opioid prescribing guidelines, which is outlined in this course. Opioids are not a panacea for pain, nor are they safe and effective for every patient. However, they can be a useful tool, and knowledge of medical advances can give clinicians greater confidence to safely and effectively prescribe these drugs.
WORKS CITED https://qr2.mobi/opioid-safety
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