Skip to main content
NCBI home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2004 Sep;96(9):1152–1161.

Managing pain: The Challenge in Underserved Populations: Appropriate Use Versus Abuse and Diversion.

Benny J Primm 1, Lucille Perez 1, Gary C Dennis 1, Lennette Benjamin 1, Westley Clark 1, Kathy Keough 1, W David Leak 1, Richard Payne 1, Deborah Smith 1, Louis W Sullivan 1; National Medical Association1
PMCID: PMC2568463  PMID: 15481743

Abstract

ISSUE: Inadequate pain management is a serious public health problem that affects a wide cross-section of Americans. Patients are often denied sufficient medication, because physicians lack training and fear scrutiny from federal and state regulatory agencies. In addition, even the state-financed system of care, Medicaid, has been increasingly denying payment for the best treatment for pain management. These factors are complicated by physician bias about various subgroups and poor physician-patient communication. Comprehensive patient assessment plays a crucial role in determining appropriate treatment and identifying potential abuse problems. Physicians must routinely document medications analgesic effects and screen for potential ill effects and drug abuse. OBJECTIVE: To examine the prevalence of the undertreatment of pain, particularly among African Americans, and to recommend relevant proactive policy and practice changes to aid in eliminating this health problem. CONSENSUS PROCESS: In July 2002, the NMA convened the "Managing Pain: The Challenge in Underserved Populations: Appropriate Use versus Abuse and Diversion" Consensus Meeting in Washington, DC. The country's most renowned experts in the area of pain management and substance abuse reviewed substantial information regarding pain management and substance abuse including the following: --A draft summary paper on pain management and substance abuse that served as briefing material for consensus members; --Annotated bibliographies; --Articles on pain management and substance abuse; and --Key presentations on pain management and substance abuse.

Full text

PDF
1152

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anand K. J., International Evidence-Based Group for Neonatal Pain Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001 Feb;155(2):173–180. doi: 10.1001/archpedi.155.2.173. [DOI] [PubMed] [Google Scholar]
  2. Anand K. J., International Evidence-Based Group for Neonatal Pain Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001 Feb;155(2):173–180. doi: 10.1001/archpedi.155.2.173. [DOI] [PubMed] [Google Scholar]
  3. Bernabei R., Gambassi G., Lapane K., Landi F., Gatsonis C., Dunlop R., Lipsitz L., Steel K., Mor V. Management of pain in elderly patients with cancer. SAGE Study Group. Systematic Assessment of Geriatric Drug Use via Epidemiology. JAMA. 1998 Jun 17;279(23):1877–1882. doi: 10.1001/jama.279.23.1877. [DOI] [PubMed] [Google Scholar]
  4. Bernabei R., Gambassi G., Lapane K., Landi F., Gatsonis C., Dunlop R., Lipsitz L., Steel K., Mor V. Management of pain in elderly patients with cancer. SAGE Study Group. Systematic Assessment of Geriatric Drug Use via Epidemiology. JAMA. 1998 Jun 17;279(23):1877–1882. doi: 10.1001/jama.279.23.1877. [DOI] [PubMed] [Google Scholar]
  5. Bonham V. L. Race, ethnicity, and pain treatment: striving to understand the causes and solutions to the disparities in pain treatment. J Law Med Ethics. 2001 Spring;29(1):52–68. doi: 10.1111/j.1748-720x.2001.tb00039.x. [DOI] [PubMed] [Google Scholar]
  6. Bonham V. L. Race, ethnicity, and pain treatment: striving to understand the causes and solutions to the disparities in pain treatment. J Law Med Ethics. 2001 Spring;29(1):52–68. doi: 10.1111/j.1748-720x.2001.tb00039.x. [DOI] [PubMed] [Google Scholar]
  7. Cleeland C. S., Gonin R., Baez L., Loehrer P., Pandya K. J. Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Ann Intern Med. 1997 Nov 1;127(9):813–816. doi: 10.7326/0003-4819-127-9-199711010-00006. [DOI] [PubMed] [Google Scholar]
  8. Cleeland C. S., Gonin R., Baez L., Loehrer P., Pandya K. J. Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Ann Intern Med. 1997 Nov 1;127(9):813–816. doi: 10.7326/0003-4819-127-9-199711010-00006. [DOI] [PubMed] [Google Scholar]
  9. Cleeland C. S. Undertreatment of cancer pain in elderly patients. JAMA. 1998 Jun 17;279(23):1914–1915. doi: 10.1001/jama.279.23.1914. [DOI] [PubMed] [Google Scholar]
  10. Cleeland C. S. Undertreatment of cancer pain in elderly patients. JAMA. 1998 Jun 17;279(23):1914–1915. doi: 10.1001/jama.279.23.1914. [DOI] [PubMed] [Google Scholar]
  11. Contro Nancy, Larson Judith, Scofield Sarah, Sourkes Barbara, Cohen Harvey. Family perspectives on the quality of pediatric palliative care. Arch Pediatr Adolesc Med. 2002 Jan;156(1):14–19. doi: 10.1001/archpedi.156.1.14. [DOI] [PubMed] [Google Scholar]
  12. Contro Nancy, Larson Judith, Scofield Sarah, Sourkes Barbara, Cohen Harvey. Family perspectives on the quality of pediatric palliative care. Arch Pediatr Adolesc Med. 2002 Jan;156(1):14–19. doi: 10.1001/archpedi.156.1.14. [DOI] [PubMed] [Google Scholar]
  13. Crawley L., Payne R., Bolden J., Payne T., Washington P., Williams S., Initiative to Improve Palliative and End-of-Life Care in the African American Community Palliative and end-of-life care in the African American community. JAMA. 2000 Nov 15;284(19):2518–2521. doi: 10.1001/jama.284.19.2518. [DOI] [PubMed] [Google Scholar]
  14. Crawley L., Payne R., Bolden J., Payne T., Washington P., Williams S., Initiative to Improve Palliative and End-of-Life Care in the African American Community Palliative and end-of-life care in the African American community. JAMA. 2000 Nov 15;284(19):2518–2521. doi: 10.1001/jama.284.19.2518. [DOI] [PubMed] [Google Scholar]
  15. Joranson D. E., Ryan K. M., Gilson A. M., Dahl J. L. Trends in medical use and abuse of opioid analgesics. JAMA. 2000 Apr 5;283(13):1710–1714. doi: 10.1001/jama.283.13.1710. [DOI] [PubMed] [Google Scholar]
  16. Joranson D. E., Ryan K. M., Gilson A. M., Dahl J. L. Trends in medical use and abuse of opioid analgesics. JAMA. 2000 Apr 5;283(13):1710–1714. doi: 10.1001/jama.283.13.1710. [DOI] [PubMed] [Google Scholar]
  17. Kagawa-Singer M., Blackhall L. J. Negotiating cross-cultural issues at the end of life: "You got to go where he lives". JAMA. 2001 Dec 19;286(23):2993–3001. doi: 10.1001/jama.286.23.2993. [DOI] [PubMed] [Google Scholar]
  18. Kagawa-Singer M., Blackhall L. J. Negotiating cross-cultural issues at the end of life: "You got to go where he lives". JAMA. 2001 Dec 19;286(23):2993–3001. doi: 10.1001/jama.286.23.2993. [DOI] [PubMed] [Google Scholar]
  19. Longo L. P., Parran T., Jr, Johnson B., Kinsey W. Addiction: part II. Identification and management of the drug-seeking patient. Am Fam Physician. 2000 Apr 15;61(8):2401–2408. [PubMed] [Google Scholar]
  20. Longo L. P., Parran T., Jr, Johnson B., Kinsey W. Addiction: part II. Identification and management of the drug-seeking patient. Am Fam Physician. 2000 Apr 15;61(8):2401–2408. [PubMed] [Google Scholar]
  21. Meisel A., Snyder L., Quill T., American College of Physicians--American Society of Internal Medicine End-of-Life Care Consensus Panel Seven legal barriers to end-of-life care: myths, realities, and grains of truth. JAMA. 2000 Nov 15;284(19):2495–2501. doi: 10.1001/jama.284.19.2495. [DOI] [PubMed] [Google Scholar]
  22. Meisel A., Snyder L., Quill T., American College of Physicians--American Society of Internal Medicine End-of-Life Care Consensus Panel Seven legal barriers to end-of-life care: myths, realities, and grains of truth. JAMA. 2000 Nov 15;284(19):2495–2501. doi: 10.1001/jama.284.19.2495. [DOI] [PubMed] [Google Scholar]
  23. Mitchell Anita, Boss Barbara J. Adverse effects of pain on the nervous systems of newborns and young children: a review of the literature. J Neurosci Nurs. 2002 Oct;34(5):228–236. doi: 10.1097/01376517-200210000-00002. [DOI] [PubMed] [Google Scholar]
  24. Mitchell Anita, Boss Barbara J. Adverse effects of pain on the nervous systems of newborns and young children: a review of the literature. J Neurosci Nurs. 2002 Oct;34(5):228–236. doi: 10.1097/01376517-200210000-00002. [DOI] [PubMed] [Google Scholar]
  25. Mitka M. Abuse of prescription drugs: is a patient ailing or addicted? JAMA. 2000 Mar 1;283(9):1126–1129. doi: 10.1001/jama.283.9.1126. [DOI] [PubMed] [Google Scholar]
  26. Morrison R. S., Wallenstein S., Natale D. K., Senzel R. S., Huang L. L. "We don't carry that"--failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. N Engl J Med. 2000 Apr 6;342(14):1023–1026. doi: 10.1056/NEJM200004063421406. [DOI] [PubMed] [Google Scholar]
  27. Morrison R. S., Wallenstein S., Natale D. K., Senzel R. S., Huang L. L. "We don't carry that"--failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. N Engl J Med. 2000 Apr 6;342(14):1023–1026. doi: 10.1056/NEJM200004063421406. [DOI] [PubMed] [Google Scholar]
  28. Orentlicher D., Caplan A. The Pain Relief Promotion Act of 1999: a serious threat to palliative care. JAMA. 2000 Jan 12;283(2):255–258. doi: 10.1001/jama.283.2.255. [DOI] [PubMed] [Google Scholar]
  29. Orentlicher D., Caplan A. The Pain Relief Promotion Act of 1999: a serious threat to palliative care. JAMA. 2000 Jan 12;283(2):255–258. doi: 10.1001/jama.283.2.255. [DOI] [PubMed] [Google Scholar]
  30. Portenoy R. K., Dole V., Joseph H., Lowinson J., Rice C., Segal S., Richman B. L. Pain management and chemical dependency. Evolving perspectives. JAMA. 1997 Aug 20;278(7):592–593. [PubMed] [Google Scholar]
  31. Portenoy R. K., Dole V., Joseph H., Lowinson J., Rice C., Segal S., Richman B. L. Pain management and chemical dependency. Evolving perspectives. JAMA. 1997 Aug 20;278(7):592–593. [PubMed] [Google Scholar]
  32. Todd K. H., Deaton C., D'Adamo A. P., Goe L. Ethnicity and analgesic practice. Ann Emerg Med. 2000 Jan;35(1):11–16. doi: 10.1016/s0196-0644(00)70099-0. [DOI] [PubMed] [Google Scholar]
  33. Todd K. H., Deaton C., D'Adamo A. P., Goe L. Ethnicity and analgesic practice. Ann Emerg Med. 2000 Jan;35(1):11–16. doi: 10.1016/s0196-0644(00)70099-0. [DOI] [PubMed] [Google Scholar]
  34. Vastag B. Mixed message on prescription drug abuse. JAMA. 2001 May 2;285(17):2183–2184. [PubMed] [Google Scholar]
  35. Vastag B. Mixed message on prescription drug abuse. JAMA. 2001 May 2;285(17):2183–2184. [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES