Good medicine, good economics: African-Americans need equal treatment for pain, SLU study finds


They're not getting it, and it's costing us all money in the long term

ST. LOUIS -- As if doing the right thing isn't enough, Saint Louis University researchers have found another reason African-Americans and the poor should receive equal medical treatment and compensation for occupational back pain.

It's actually cheaper in the long run, concludes study author John T. Chibnall, Ph.D., associate professor of psychiatry at Saint Louis University School of Medicine.

Research by Chibnall and Raymond C. Tait, Ph.D., professor of psychiatry at Saint Louis University School of Medicine, in Pain Medicine finds that the cheaper treatment and smaller settlements typically given to African-Americans and the poor lead to greater dissatisfaction with the Workers' Compensation system, which in turn creates more long-term disability and costs.

The study is a companion to recent work by the authors, which found that African-Americans and poor people with work-related back injuries receive less medical care and smaller compensation packages than Caucasians.

"We looked at the relationship between their satisfaction with the process and their self-reported disability nearly two years after their claims were settled," Chibnall says.

"African-Americans got less treatment and compensation for their pain, all other things being equal. This made them more dissatisfied, and more likely to report higher rates of disability later. That also held for poor people."

The study examined 1,475 Missouri Workers' Compensation back pain cases, which were settled between Jan. 1, 2001, and June 1, 2002. Researchers used Workers' Compensation archives and patient interviews as sources of data.

"As an insurance system that provides uniform coverage for workers injured in the course of their employment in the United States, Workers' Compensation should be equitable with regard to case management of persons with low back injuries, regardless of race or socioeconomic status. Similarly, outcomes of treatment, all other things being equal, should be roughly equivalent," Chibnall says.

"The current data suggest that these expectations may not apply for African-American and lower social economic claimants in Missouri. Not only were these groups less compensated with respect to medical treatment, temporary disability, case settlement and disability rating, they were also less satisfied with the Workers' Compensation process and reported higher levels of post-settlement disability."

Higher disability carries a cost, he notes, which is disproportionately borne by African Americans and those who are poor.

In addition to the work by Chibnall and Tait, other recent studies have agreed that dissatisfaction with the Workers' Compensation process stimulates continued legal activity and prolongs disability, including failure to return to work. Claimants with unresolved disability may turn to the Social Security Disability Insurance (SSDI) system and never return to work, Chibnall says. In fact, Chibnall and Tait found that African-Americans were one-and-a-half times more likely than Caucasians to have applied for SSDI within two years of case settlement.

"Some level of the system will bear the cost," Chibnall says. "If treatment and compensation for work-related back pain injuries were more equitable, particularly along racial and socioeconomic lines, claimants would be more satisfied with their experience and better off in the long run. The point of the system is to return people to work and to give them a fresh start after their injury, not to encourage costly legal wrangling and disability applications."

This month's issue of Pain Medicine is devoted to addressing disparities in pain care for racial and ethnic minorities.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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