Systemic problems rather than patient-physician relationship most likely reason for racial disparities in chronic low back pain

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The disparities in chronic low back pain experienced by Black patients compared to White patients are not linked to the patient-physician relationship but are more likely the result of systemic factors, such as access to high-quality medical care, new research indicates. The study, which was published in JAMA Network Open by John Licciardone (University of North Texas Health Science Center, Texas, USA) et al, suggest that consideration of the availability of health insurance, the healthcare setting, and access to specialised pain treatment, may identify more promising approaches to mitigate racial pain disparities.

The researchers note that racial and ethnic disparities in pain outcomes “are widely reported in the United States. However, the impact of the patient-physician relationship on such outcomes remains unclear”. As such, the cross-sectional study sought to determine whether the patient-physician relationship mediates the association of race with pain outcomes.

Data were collected from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) registry between April 2016 and December 2021. Those who identified as either Black or White with chronic low back pain and who had a regular physician who provided pain care were included.

Primary outcomes included low back pain intensity, measured with a numerical rating scale, and physical function, measured with the Roland-Morris Disability Questionnaire. Mediator variables were derived from the Communication Behaviour Questionnaire, Consultation and Relational Empathy measure, and Patient Satisfaction Questionnaire.

In all, 1,177 patients were included. The mean (standard deviation [SD]) age was 53.5 (13.1) years, and 876 (74.4%) were women. A total of 217 participants (18.4%) were Black, and 960 participants (81.6%) were White.

The study found that the only difference between Black and White participants in the patient-physician relationship involved effective and open physician communication, which favoured Black participants (mean communication score, 72.1; 95% confidence interval [CI], 68.8–75.4 vs. 67.9; 95% CI, 66.2–69.6; p=0.03).

Black participants, compared with White participants reported worse outcomes for pain intensity (mean pain score, 7.1; 95% CI, 6.8–7.3; vs. 5.8; 95% CI, 5.7–6.0; p<0.001) and back-related disability (mean disability score, 15.8; 95% CI, 15.1–16.6 vs. 14.1; 95% CI, 13.8-14.5; p<0.001).

In mediation analyses that controlled for potential confounders using disease risk scores, virtually none of the associations of race with each outcome was mediated by the individual or combined factors of physician communication, physician empathy, and patient satisfaction. Similarly, no mediation was observed in sensitivity analyses that included only participants with both chronic low back pain and the same treating physician for more than five years.


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