National pain registry finds widening racial disparities in low back pain treatment, outcomes

Pain Registry Licciardone
Dr. John Licciardone

The Journal of Pain has published an article in its March issue comparing treatments and outcomes among Black and white patients with low back pain. The article is based on national data collected by the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) at The University of North Texas Health Science Center at Fort Worth.

The article is titled “Racial Disparities in Opioid Use and Lumbar Spine Surgery for Chronic Pain and in Pain and Function Over Three Years: A Retrospective Cohort Study,” and the research team was led by John C. Licciardone, DO, MS, MBA, PRECISION director. Other investigators included Chase Miller, Alex Nazzal, Christian Hernandez and Linh Nguyen, all students at HSC’s Texas College of Osteopathic Medicine, and Subhash Aryal, PhD, a registry biostatistician currently affiliated with Johns Hopkins University.

The study included 1,443 patients nationwide with chronic low back pain. Throughout three years of follow-up, the odds of Black patients using opioid therapy were 40% greater than white patients. The odds of Black patients having lumbar spine surgery were 55% less than white patients. In addition, Black patients reported significantly greater pain intensity and functional disability than white patients.

The racial disparities in lumbar spine surgery were considered large, and pain and function disparities widened over time. These findings suggest that barriers to guideline-adherent and specialized care for chronic low back pain among Black patients may be expanding and that greater efforts are needed to address the observed racial disparities.

Chasemiller
Chase Miller

“This publication is an important addition to the literature because it uses data that was collected over three years, whereas most other publications do not collect longitudinal data or collect data over a shorter period,” TCOM student Chase Miller said. “I gained a significant amount of research experience from the project, including the fundamentals of conducting research and reading related papers. Taking part in the research project allowed me to gain experience from the ground up.”

Licciardone, who also contributed to the Federal Pain Research Strategy developed in 2017 by the National Institutes of Health, questioned whether national objectives to improve access to high-quality pain services among vulnerable populations are being met. The Centers for Disease Control and Prevention has reported that Black adults are disproportionately impacted by pain compared with other racial or ethnic groups.

“Our study findings should concern national health policymakers,” Licciardone said. “Greater efforts are needed to address the racial disparities we observed. An emerging strategy for planning and improving chronic pain treatment services for Black patients involves considering race as a social framework in the context of other sociodemographic factors and social determinants of health.”

The research extends that previously conducted by PRECISION and published in 2022 in the JAMA Network. Similar racial disparities in pain and function were observed. However, this new research further demonstrates disparities in opioid prescribing and lumber spine surgery, as well as worsening treads in pain and function over time.

The full text of the article can be found here. To learn more about PRECISION, contact Samantha Johnson at samantha.johnson@unthsc.edu or 817-735-0532.

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