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Papers: 30 Sep 2023 - 6 Oct 2023

2023 Sep 28

J Pain


Racial Disparities in Opioid Use and Lumbar Spine Surgery for Chronic Pain and in Pain and Function over Three Years: A Retrospective Cohort Study.


Licciardone JC, Miller CL, Nazzal AJ, Hernandez CT, Nguyen LH, Aryal S


This study aims to compare treatments and outcomes among Black and White patients with chronic low back pain in the United States. A retrospective cohort study was conducted within a pain research registry, including 1443 participants with up to 3 years of follow-up. Pain treatments were measured at quarterly research encounters using reported current opioid use and prior lumbar spine surgery. Pain intensity and functional disability were also measured quarterly with a numerical rating scale and the Roland-Morris Disability Questionnaire, respectively. Longitudinal data were analyzed with generalized estimating equations, including multivariable models to measure temporal trends and to adjust for potential confounders. The mean baseline age of participants was 53.5 years (SD, 13.1 years); 1074 (74.4%) were female; and 260 (18.0%) were Black. In longitudinal multivariable analyses, Black participants reported more frequent current opioid use (OR, 1.40; 95% CI, 1.03-1.91; P=0.03) and less frequent lumbar spine surgery (OR, 0.45; 95% CI, 0.28-0.72; P<0.001). Black participants also reported greater pain intensity (mean, 6.6; 95% CI, 6.3-6.9 vs. mean, 5.6; 95% CI, 5.4-5.8; P<0.001) and functional disability (mean, 15.3; 95% CI, 14.6-16.0 vs. mean, 13.8; 95% CI, 13.2-14.3; P=0.002). Racial disparities were clinically important (RR=1.28 and RR=0.49, respectively, for opioid use and surgery; and d=0.46 and d=0.24, respectively, for pain and function). Racial disparities in pain and function also widened over time. Thus, barriers to guideline-adherent and specialized pain care among Black patients may affect pain and function outcomes. Greater efforts are needed to address the observed racial disparities. PERSPECTIVE: Widening racial disparities in pain and function over time indicate that new approaches to chronic pain management are needed in the United States. Considering race as a social framework represents an emerging strategy for planning and improving pain treatment services for Black patients.