®
Low Back Pain and Physical Function Among
Different Ethnicities
Adelle A Safo, Sarah Holder DO, Sandra Burge PhD
The University of Texas Health Science Center at San Antonio
Introduction
Results
According to the American Chiropractic
Association, over 30 million Americans
have had low back pain at some point in
their lives1. The total cost of low back pain
in 1986 was around $11.1 billion dollars2.
Previous researchers have uncovered
disparities in the presentation and
treatment of low back pain, finding that
African American individuals report more
severe pain than Caucasian individuals3.
Other research has examined racial
disparities in pain severity, and found that
different racial groups experience pain in a
similar fashion 4. Few studies have
addressed racial or socioeconomic
disparities in physical functioning of
patients with low back pain. In this study,
we will examine ethnic and socioeconomic
differences in pain severity, physical
function, and treatments for pain.
In this study, 30.8% patients were Hispanic,
45.2% were Caucasian, and 23.9% were
African American. 27.5% of the subjects were
male and 71.9% were female. Out of the three
racial groups, African Americans had the worst
pain (p=.001), the worst role functioning score,
(p=.019) and the worse physical function score
(p=.079). See Figure 1, 2 and 3. Opioid usage
did not differ significantly between ethnic
groups and education levels. We found
disparities by insurance status. Individuals
with private insurance were much less likely
than the rest of the sample to take opioids,
while those on government insurance were
very likely to use opioids for pain. (p = .000).
Individuals with private insurance had the
lowest pain severity (p=.031) and higher
physical function scores (p = .001). Individuals
with college education or higher had the
highest health score (p=.010) and least
amount of pain (p=.073) and individuals that
had below a 12th grade education had the
lowest healthscore, and highest amount of
pain.
Figure 2: Mean Physical Function Score
Methods
Subjects. Student research assistants
enrolled 367 adult patients from 9 outpatient
clinics across Texas. Patients were eligible
if they had low back pain for 3 months or
longer, and were excluded if they were
pregnant or had a diagnosis of cancer.
Procedure and Measurement. Students
gathered data from patient surveys and
medical records. A 6-page patient survey
addressed demographic characteristics,
pain duration, frequency and severity,
physical functioning and general health,
anxiety, depression, substance abuse, and
risk for opioid misuse. Patients reported
pain severity using a 10-point
scale. Investigators assessed physical
function, role function, and general health
using composite scores based on items
from the MOS Short Form-36. Ten items
addressed physical function (ability to
perform physical activities); four items
addressed role function (ability to perform
daily work); and four items addressed
general health (feelings of wellness versus
illness). In all 3 scales, a higher score
indicated higher function or better health.
From participants’ medical records, students
gathered information about causes of low
back pain, treatments for pain (including
medications, procedures, and surgeries),
comorbidities, and Body Mass Index (BMI).
African American
3
12th Grade or GED
Figure 1: Mean Pain Severity
12
Maximum
African American
10
8
Hispanic
p = .079
p = .001
Caucasian
p = .610
Private Insurance
6
Government Insurance
County/Self Pay/Other
4
Below 12th Grade
12th Grade or GED
2
Some College
0
2.5
Private Insurance
Government Insurance
County/Self Pay/Other
p = .079
0.5
Below 12th Grade
0
Caucasian
1
Government
Insurance
County/Self
Pay/Other
0.5
Hispanic
p = .579
Private Insurance
1
African American
p = .019
p = .073
1.5
3.5
1.5
p = .031
2
Maximum
2
Caucasian
p = .001
4.5
3
Hispanic
2.5
Figure 3: Mean Role Function Score
4
Maximum
3.5
Below 12th Grade
12th Grade or GED
Some College
0
Acknowledgements
This study was conducted in the Residency Research Network of Texas (RRNeT)
with support from the Dean’s Office, School of Medicine, UTHSCSA; the Texas
Academy of Family Physicians; the South Texas Area Health Education Center;
the National Center for Research Resources (Award # UL 1RR025767); and the
Health Resources and Services Administration (Award # D54HP16444). The
content is solely the responsibility of the authors and does not necessarily
represent the official views of the National Center for Research Resources of the
National Institutes of Health.
Conclusions
This study of patients with chronic low back pain
demonstrated a clear difference between
African Americans and other racial/ethnic
groups. African Americans had significantly
worse pain and role function. Likewise,
insurance status and education, indicators of
socioeconomic status, were associated with
pain, function, and use of opioids, This finding
is in contrast to other research studies which
found that socioeconomic status and ethnicity
did not significantly affect the rate of prescription
of various treatments 5. More research needs
to be done in order to determine the specific
reasons why African Americans have worse
pain than other groups. In addition, future
studies should investigate other factors related
to opioid use, such as occupation, hours
worked, and other social, economic and cultural
factors.
References
1. "ACA - Back Pain." ACA - The American Chiropractic Association (ACA) - Representing doctors of
chiropractic - A treatment met. N.p., n.d. Web. 3 Sept. 2010.
<http://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68>.
2. Webster, Barbara . "The Cost of Compensable Low Back Pain ." Journal of
Occupational and Environmental Medicine 32.1 (1990): 13-5.. Print
3. Edwards, Robert. "Ethnic Differences in Pain Tolerance: Clinical Implications
in a Chronic Pain Population ." Psychosomatic Medicine 63:316-323 (2001)
63.2 (2001): 316-323.
4. Edwards, Robert. "Ethnic Similarities and Differences in the Chronic Pain
Experience: A Comparison of African American, Hispanic, and White Patients."
Pain Medicine 6.1 (2005): 88-98
5. Nampiaparampil , Devi. "Pain and Prejudice." Pain Medicine 10.4 (2009):
716-721