WASHINGTON – African American cancer patients are heterogeneous in their need for pain medication, Salimah Meghani, Ph.D., said at a meeting sponsored by the Department of Health and Human Services and the Office of Minority Health.
Dr. Meghani interviewed 36 self-identified African American cancer patients from three outpatient oncology clinics in Philadelphia; all were over age 18 years and had solid tumors. All of the patients had self-reported pain at least 1 month in duration during the last 6 months; none had had major surgery in the prior 3 months.
The patients filled out a 32-item self-report instrument assessing pain severity and its impact, and researchers conducted open-ended interviews lasting 50–70 minutes. To ensure reliability among coders, 15% of the transcripts were independently coded by Dr. Meghani and a consultant.
The patients were 33–75 years old. Slightly more than half were male, two-thirds were single, and 89% were Christian, said Dr. Meghani, a postdoctoral fellow at the Center for Health Disparities Research at the University of Pennsylvania, Philadelphia. Almost all of the patients were insured; the median annual household income was in the $20,000-$30,000 range.
Only one-third of the patients said they preferred to take pain medication regularly. Overall, 25% said they were concerned about taking too much pain medication, and 36% said they had problems with side effects from pain medication. On the other hand, 19% of the patients said they needed more pain medication and 36% said they needed stronger medication.
Dr. Meghani separated 35 of the patients into three categories. (One patient did not participate in the interview and so could not be categorized.)
The first category, which included four patients, was called “nonbelievers.” They didn't want to take too much pain medication for fear that it would hide recurring disease.
The second, more middle-of-the-road category (“centralists”) included 24 patients. They tended to take their pain medication despite their ambivalence about it. Dr. Meghani quoted one patient in this group: “I wish I could stop [taking the medication,] but I know I can't, so I have to deal with it.”
The third category, called “strong believers,” included seven patients. These patients were strongly in favor of taking pain medication, with one of them quoted as saying, “I don't mind taking [pain medicine] because it relaxes me and it keeps the pain down and it gives me a chance to get my rest.”
The study had several limitations, including a small sample size and lack of accounting for type or stage of illness, type or strength of the prescribed medication, and history of dependency. But the results showed that black patients cannot be put into a “one-size-fits-all” category regarding pain management, Dr. Meghani said.