Association of the Patient-Physician Relationship with Racial Disparities in Chronic Pain Outcomes

Date

2023

Authors

Pu, Ryan
Ganta, Sweta
Goehring, Leah
Wallace, Kendall

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Racial disparities involving health outcomes in the United States have been widely investigated. However, the role of the patient-physician relationship in these disparities remains unclear. Of interest, Black patients may experience different treatment and outcomes relating to pain management. This research aims to determine if the patient-physician relationship mediates the association between race and pain outcomes among patients with chronic low back pain. Methods: Participants in this study were selected from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) from April 2016 through December 2021. All participants were 21 to 79 years of age, had chronic low back pain according to criteria established by the National Institutes of Health, and had a physician who regularly treated their low back pain. Primary outcomes included low back pain intensity measured with a numerical rating scale and physical function measured with the Roland-Morris Disability Questionnaire. The patient-physician relationship variables were derived from the Communication Behavior Questionnaire, Consultation and Relational Empathy Measure, and Patient Satisfaction Questionnaire. Mediation analyses were performed with the PROCESS v4 software, using multiple mediation models and 95% bootstrap confidence intervals. Results: A total of 1177 participants were studied, including 217 and 960 Black and White participants, respectively. Black participants reported worse outcomes for pain intensity (mean, 7.1; 95% CI, 6.8-7.3 vs. mean, 5.8 95% CI, 5.7-6.0; P< 0.001) and back-related disability (mean, 15.8; 95% CI, 15.1-16.6 vs. mean, 14.1; 95% CI, 13.8-14.5; P< 0.001). The differences in the patient-physician relationship between Black and White participants were not significant, with the exception that Black participants experienced more open and effective communication with their physicians than White participants (mean, 72.1; 95% CI, 68.8-75.4 vs. mean, 67.9; 95% CI, 66.2-69.6; P=0.03). In the mediation analyses, virtually none of the association between race and each outcome was mediated by the individual or combined effects of physician communication, physician empathy, and patient satisfaction. Conclusions: These findings suggest that factors other than the patient-physician relationship are important drivers of pain disparities experienced by Black patients in the United States. Additional research on system factors, such as access to high-quality medical care, may be helpful in identifying more promising approaches to mitigating racial pain disparities.

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