New Study Suggests Patient-Physician Relationship does not Impact Pain Disparities

FJ Thomas

Sarasota, FL ( – Studies have shown that the patient-physician relationship is a direct factor in outcomes. Additionally, some studies suggest that the patient-physician relationship element is more evident in 6 months after rehabilitation, as compared to during the rehabilitation episode, especially in cases of low back pain.

While strides have been continuing the last few years on the racial front, evidence has shown there are still disparities in healthcare regarding race, especially in regards to managing pain. In one Canadian study, nurses were asked to make pain treatment recommendations after watching videos of matched facial expressions in white and Black patients. The nurses made more aggressive recommendations for white patients, which correlated to higher empathy ratings as well, suggesting that more work needs to be done in equalizing care.

With Medicare recently announcing that there were inaccuracies in their Medicare race and ethnicity data, some of the burden for getting a clear picture of racial equity in healthcare may be up to researchers. Analysts from the University of North Texas Health Science Center in Fort Worth set out to answer the question, does the patient-physician relationship balance the association between race and chronic pain outcomes?

A cross-sectional study was done from April 2016 to December 2021 of patients aged 21 to 79 with chronic low back pain. Requirements for the study included having low back pain for at least 3 to 6 months, with a frequency of pain for at least half of the days within the last 6 months. Medical history was used to gather data on diagnoses, and current use of opioids for pain control was also measured. The patient-physician relationship was assessed through questions on level of communication, perceived empathy, general satisfaction of medical care, bedside manner, and time spent. Outcomes were measured through questions on pain intensity and level, adverse impacts of the back pain, and disability levels.

Of the 1,177 patients, the average age was 53.5, with 74.4 percent women. When broken out by race, 18.4 percent were Black patients, and 81.6 percent were white patients. The patients varied greatly in sociodemographic, psychological, and clinical characteristics.

The researchers noted that there were no significant differences in the use of opioids between Black and white patients. However, Black patients reported worse outcomes for pain intensity. When asked about work loss of greater than 1 month, 49.8 percent of Black patients compared to 40.1 percent of white patients stated they had not worked. Thirty one percent of the Black patients stated they experienced chronic widespread pain, compared to 25.3 percent of the white patients. However, only 8.8 percent of Black patients compared to 21.4 percent of white patients had a history of low back surgery.

Thirty-one percent of the Black patients compared to 21 percent of white patients stated they had received disability or worker’s compensation due to low back pain. Fourteen percent of the Black patients compared to 8 percent of white patients stated they were involved in legal action due to low back pain.

When asked about the patient-physician relationship, interpersonal manner was listed as the most favorable aspect by both patient groups. Communication about personal circumstances was reported as the as the least favorable aspect overall.

Overall, the researchers found clear associations of race and pain intensity as well as disability, with clear pain differences among Black patients. The researchers believe there may be characteristics that could have affected the association between race and pain outcomes. The researchers also concluded that the patient-physician relationship, physician empathy or communication did not mediate those differences and believe that more work needs to be done exploring other aspects of healthcare to determine the differences in outcomes.