Pain and prejudice

Pain Med. May-Jun 2009;10(4):716-21. doi: 10.1111/j.1526-4637.2009.00612.x. Epub 2009 Apr 22.


Background: The primary objective of this pilot study is to understand the relationship between physicians' characteristics and physicians' management decisions about pain. The secondary aim is to understand how patient characteristics, including race/ethnicity and socioeconomic status (SES) may affect these treatment decisions in chronic low back pain.

Methods: We conducted a double-blinded randomized controlled study using a survey instrument. Ninety physicians were randomly allocated one of two scenarios of a patient with chronic low back and lower extremity pain. In one version, the patient is a Caucasian male with Blue Cross health insurance. In the other version, the patient is an African American male with Medicaid. All other aspects of the survey scenarios are identical. The physicians were subsequently presented with questionnaires about their treatment plans. We analyzed the physician demographic variables in addition to patient ethnicity and SES to differentiate which variables affected treatment preferences.

Results: Based on bivariate analysis, physician specialty, gender, ethnicity, and professional status significantly affected treatment plans, including analgesic prescription and referrals for invasive therapy. Patient ethnicity/SES trended toward significance for the prescription of opioids.

Conclusion: Our study is the first randomized controlled study assessing patient and treatment variables in the management of chronic pain. It suggests that physicians' demographic variables and perhaps patient demographic variables influence pain management decisions.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Attitude of Health Personnel
  • Continental Population Groups
  • Data Collection
  • Decision Making
  • Double-Blind Method
  • Health Services Accessibility / statistics & numerical data
  • Health Status
  • Health Status Disparities
  • Humans
  • Insurance, Health / ethics
  • Pain / epidemiology*
  • Pain / psychology
  • Pain Management*
  • Patient Satisfaction
  • Physician-Patient Relations / ethics*
  • Pilot Projects
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prejudice*
  • Prescriptions / statistics & numerical data
  • Quality of Health Care / ethics
  • Quality of Health Care / statistics & numerical data
  • Referral and Consultation / statistics & numerical data
  • Social Class*
  • Surveys and Questionnaires