How health care providers respond to patients’ descriptions of their pain ultimately determines how that pain is managed.
An innovative project hopes to shine a light on how health care providers assess their patients’ risk of opioid misuse, with the goal of improving pain management as part of the national response to the opioid crisis.
Funded as part of the Clinical Research in Pain Management program of the Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative®, this study highlights the role of medical professionals in addressing the opioid epidemic and reducing disparities in pain care.
Doctors participating in the study log in to a computer simulation program where they “meet” animated virtual patients of different races and health histories, each of whom has an opioid prescription for chronic pain, explained Adam T. Hirsh, Ph.D., associate professor of psychology in the Purdue School of Science at Indiana University–Purdue University Indianapolis and principal investigator of the project.
In some of the simulations, the patients will have taken their medicines exactly as prescribed. In others, the doctors will learn that the patients have not used their medicines as prescribed. For example, maybe they ran out of their prescription early, a sign that the patients might have taken extra doses.
Each doctor will go through similar scenarios with a total of eight different virtual patients. Just as in real life, the doctors must assess the patient’s risk of not using opioids as prescribed, misusing them, or becoming addicted. Then, the doctors will decide whether to continue the opioid prescription, reduce the dose over time, or stop it completely.
At the end of the simulation, Hirsh and his team will be able to see whether the doctors’ evaluations for potential opioid misuse and treatment decisions were influenced by the virtual patients’ race or income level. Eventually, data collected from 135 doctors participating in the project would help design a solution to reduce racial or socioeconomic biases in the treatment of patients with chronic pain.
The root of the problem
People of all races and income levels suffer from chronic pain; but their doctors are far more likely to be white and have higher incomes.1 This contrast can lead providers to make false assumptions or judgments about patients and create inconsistencies in treatment decisions.
Do these judgments and assumptions, called provider bias, create disparities in pain care? If so, how can providers overcome their biases as they assess patients’ risk for opioid misuse and recommend treatments for their pain? These are questions that Hirsh and his colleagues are trying to answer with their computer simulation project.
“Black patients in particular are less likely to receive guideline-based pain treatment, perhaps because their providers perceive them as being riskier in terms of the potential for misuse and addiction,” Hirsh said.