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Minority Populations
In general, minority patients are likely to receive less adequate cancer treatment.50; F169 Indexing the adequacy of cancer pain management by WHO standards, a recent multicenter study found that minority patients (African-Americans and Hispanics) with pain due to metastatic cancer were three times more likely to have inadequate pain treatment than those seen in nonminority settings.93
The barriers that limit pain control in nonminority patients are even more likely to impede the pain management of minority patients. Cultural and linguistic differences may impair adequate assessment. Less frequent followup care will also lead to less adequate identification and monitoring of pain. Health care providers may be more concerned about the potential addiction of minority patients who need opioid medications on a chronic basis, and many minority patients may be more reluctant to use analgesics they see as potentially addicting. Because of concerns about theft and violence, pharmacies in neighborhoods where minorities live may not stock opioid analgesics.248 Minority patients are more often economically disadvantaged, leading to inadequate reimbursement for pain control. Patients and families may face the dilemma of choosing between paying for pain medications or paying for other necessities.
Patients from special populations, because of their behavior when they have pain, may also be perceived as needing less aggressive pain management. Health care professionals frequently comment that such patients seem to have less pain even when they have equally severe tissue damage, because pain in these patients is inadequately assessed, but patients from diverse cultural and linguistic backgrounds will rate their pain at a similar level of severity when given the appropriate pain rating scales.89 Judging pain by just observing the behavior of the patient will lead to consistent underestimation of its severity.190Therefore, when developing a pain treatment plan, health care clinicians should be aware of the unique needs and circumstances of patients from various ethnic and cultural backgrounds.
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