Racial and Ethnic Disparities in the Evaluation and Management of Pain in the Outpatient Setting, 2006-2015

Objective Much is known about racial and ethnic disparities in receipt of opioids for pain in emergency departments. Less is known about such disparities in the evaluation and management of pain in the outpatient setting. Methods Using the nationally representative National Ambulatory Medical Care Survey (NAMCS), we estimated disparities in visit time with physicians and opioid receipt in the outpatient setting. We focused on patients whose reason for visiting was abdominal pain or back pain. Our sample included 4,764 white patients, 692 black patients, and 682 Hispanic patients. Results Back pain visits of Hispanic patients lasted 1.6 fewer minutes than those of white non-Hispanic patients (P=0.04 for the difference). Black patients were 6.0% less likely than white patients to receive opioids for abdominal pain (P=0.04 for the difference) and 7.1% less likely than white patients to receive opioids for back pain (P=0.046 for the difference). Hispanic patients were 6.3% less likely than white patients to receive opioids for abdominal pain (P=0.003 for the difference) and 14.8% less likely than white patients to receive opioids for back pain (P<0.001 for the difference). Hispanic patients were more likely than white patients to receive nonopioids instead of opioids for both abdominal pain and back pain. Differences in opioid receipt did not narrow during the examined time period. Conclusions Identifying causes of racial and ethnic disparities in the evaluation and treatment of pain in the outpatient setting is important to improving the health and function of patients.