Ethnic Factors in Pain Management: Is Anyone Listening?

Considerable evidence demonstrates substantial disparities in the prevalence, treatment, progression and outcomes of pain related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. Over recent years, accumulating confirmation has identified a variety of processes, from neurophysiological factors to structural elements of the healthcare system, which may contribute to shaping individual differences in pain. Diversity refers to human characteristics that are different from your own and from those of groups to which you belong. Diversity may be visible or invisible. Visible diversity is external and includes age, race, ethnicity, gender, and physical attributes. Invisible diversity includes those attributes that are not readily seen, such as work experience, marital status, educational background, parental status, income, religious beliefs and affiliations, geographic location, or socioeconomic status. Patient populations in most clinical settings are demographically di-verse. The diversity of approaches for lumbar spine pain for example suggests perhaps that the ideal technique has not been determined for the treatment of low back pain. Multidisciplinary approaches to the manage-ment of low back pain for example may be expected to be most beneficial in diverse populations as opposed to only one single therapy. The nature of the particular patient population being treated enhances our understanding of potential differences in the definition of symptom issues, variation of clinical practice, and cultural and psychosocial influences. It is unfortunate that many academic pain text books do not address diversity in pain treatments and only present a "one size fits all approach". Human characteristics imply diversity and therefore, medical treatments must address diversity to be effective. However, the question that remains to be answered: is anyone listening?