Disparities Based on Demographic Features in the Intensity and Treatment of Chronic Pain in US Patients With Spinal Cord Injury.

ABSTRACT

OBJECTIVE: Informed by Minority Stress Theory, to investigate disparities in pain intensity, interference, and care in patients with spinal cord injuries (SCI) based on demographic features. DESIGN: Cross-sectional survey. SETTING: Outpatient SCI clinics in 2 academic medical centers in the northwestern United States. PARTICIPANTS: Sample of 242 SCI clinic patients who endorsed SCI-related pain, were ≥18-years-of-age, English-fluent, not diagnosed with bipolar or psychotic disorders, and able to make their own medical decisions. Participants were 74.8% men, an average of 48.5 years (range 18.1-89.8 years), 76.2% White, 31.9% privately insured, and 64.7% making <$50,000 per year. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Exploratory analyses of screening data from a randomized controlled trial for pain treatment. Primary outcomes included pain intensity, pain interference, and the patient report of recommended pain treatments by a medical provider, tried by the patient, or that the patient would be willing to try. RESULTS: More treatments recommended was associated with younger age (ρ=-0.14, 95% confidence interval [CI] -0.01 to -0.27, P=.03) and private insurance (ρ=-0.15, 95% CI 0.02-0.27, P=.03), whereas more treatments tried was associated with private insurance alone (ρ=0.20, 95% CI 0.07-0.32, P=.003). Number of treatments willing to be tried was associated with lower income (ρ=-0.15, 95% CI -0.02 to -0.28, P=.03). SCI patients of color (PoC) reported higher pain intensity (Cohen's d=0.41, 95% CI 0.11-0.71) and greater odds of receiving psychotherapy for pain (odds ratio 7.12, 95% CI 1.25-40.46) than their White peers. CONCLUSIONS: These exploratory findings indicate differences in SCI-related pain intensity based on identifying as PoC, and differences in SCI-related pain treatment modalities based on identifying as PoC, age, insurance type, and income. Further work exploring differences in SCI-related pain care based on patient social identities is warranted.