A decade ago, the Institute of Medicine said new strategies were needed to reduce barriers to pain care.
In an editorial published in the journal Pain Management Nursing, Associate Professor Marian Wilson and Enrico De Luca, of University ‘Sapienza’ of Rome, Italy, say there’s still much work to be done.
Wilson and De Luca lay out persistent disparities in pain management. People with lower incomes, less education, from underrepresented groups, or living in rural areas all might have fewer options for pain management than others.
In some cases it’s a matter of insurance. Nonpharmacologic therapies such as yoga, meditation, massage, nutritional supplements and acupuncture all have been shown to be helpful for pain management, but “the under- or uninsured will likely not be granted the same treatment opportunities and will bear more out-of-pocket cost burden” for such treatments, Wilson and De Luca say.
Other inequities exist in the prescribing of opioids. People in rural communities are more likely to receive opioids than their urban counterparts, in part due to lack of access to non-medicine pain management approaches. And when opioids are prescribed, non-Hispanic white people have been found to receive higher dosages than other patients for the same conditions.
“From the available data to date, it does not appear that equity exists in treatment for chronic or acute pain management,” Wilson and De Luca write.
Related: Dr. Marian Wilson’s COMFORT study – “Community-Engaged Options to Facilitate Opioid Reduction” – is ongoing. In collaboration with the Spokane Regional Health District, the University of Washington Institute for Translational Health Science and the Rayce Rudeen Foundation, Dr. Wilson is investigating how adults prescribed opioids for chronic noncancer pain respond to non-opioid options of massage therapy, yoga therapy, chiropractic and physical therapies for pain-related symptoms.
In this context, the authors discuss opportunities for nurses to improve pain management and equity in pain care delivery. An example is Caring Massage, an affordable, accessible tool used by nurses to reduce pain, discomfort, and improve sleep. Massage and caring touch have also been found to alleviate nurses’ compassion fatigue and improve nurse-patient relationships.
Wilson and De Luca conclude, “It is time for an atmosphere of pain care abundance where safe, effective pain treatment options are plentiful and address all pain forms for all types of human beings.”
Editorial: “Equitable Integrative Pain Care: Are We There Yet?”, Pain Management Nursing. By Marian Wilson, PhD, MPH, RN, PMGT-BC; and Enrico De Luca, PhD, MEdu, RN.