Treating Pain in Marginalized Populations: The Role of Social Determinants of Health

AAOA welcomes guest bloggers to share their perspectives on how to prevent the misuse and abuse of prescription opioids. This is the fourth post in our “Spotlight Series” in collaboration with AAOA partner PA Foundation on how PAs across the country are working to raise awareness about the rights, risks and responsibilities associated with prescription opioids. This post is written by Andrea Lowe, PA, Director of Health Equity and DE&I initiatives at AAPA.

Health is determined not just by physical ailments, but also by environmental factors such as income, education and community. These environmental factors are called social determinants of health (SDOH). SDOH include factors such as where people are born, their access to education, what jobs they can get and the types of communities they live in. These factors impact every aspect of life, including health. People who have been economically or socially marginalized are especially at risk for negative health outcomes.

Challenges Facing Economically and Socially Marginalized Populations

Pain is often undertreated among economically and socially marginalized populations. Due to systemic health inequities, members of these communities may have limited or inconsistent access to a primary care provider or pain specialist. This leads to poor health outcomes and challenges in the proper treatment of pain management.

Social determinants of health can have critical implications for a patient’s care and health outcomes. Lack of access to care, medications and healthy foods can impact health in a significant way. Members of socially marginalized communities also may confront racial, social and other biases in their healthcare.

Patient and provider education around treatment protocol standards are two very important components in helping to prevent prescription opioid misuse and abuse. There are unique challenges when it comes to educating socially and economically marginalized populations about the rights, risks and responsibilities of prescription opioid use as well as alternative pain management options. One of the biggest challenges is connecting patients with healthcare providers or pharmacists due to enduring gaps in access to healthcare, whether it be lack of insurance or lack of access to free or reduced-fee community healthcare services.

Additionally, it can be difficult for patients who have been chronically underserved to fully trust healthcare systems and their providers. Inconsistent access to providers, diagnostics, medications and treatment services can lead to gaps in care and a lack of accountability for both patient and provider. The resulting lack of trust within the patient-provider relationship is particularly prevalent in situations where patients see a different provider each time they need medical care. Without an established relationship, important conversations about the safe use of medications may be neglected. This is especially problematic when opioids are prescribed for pain. Therefore, it is critical for communities to develop healthcare safety nets that provide patients with access to providers who can cultivate strong relationships with them and more effectively educate them on pain management.

The Role of PAs

So, how can PAs work to improve access to healthcare and increase education and awareness around the rights, risks and responsibilities of prescription opioids for these patients?

One of the most important things that PAs like myself are doing is making sure patients have access to vital services. PAs not only provide primary care, but also fill critical healthcare access gaps. Many PAs travel to rural locations, patient homes and other hard-to-reach or underserved areas to ensure fair and equitable access to medical services. With the rise in telemedicine, PAs are also taking advantage of new communication channels to build relationships and meet the needs of patients online.

As I consider the challenges facing those who have traditionally been marginalized in the healthcare system, I encourage my PA peers to adopt a holistic mindset in treatment. Chronic pain affects everyday life, but everyday life also affects chronic pain. When it comes to treating patients with pain, we should not only ask about the pain itself, but also ask about housing, education, employment and other social determinants of health, as these factors are just as impactful. “Creature comforts” can impact the outcomes of any patient’s treatment. It is especially hard to manage pain when basic needs like food and shelter are not being met. Being upfront and addressing SDOH helps improve patient care outcomes and ensures patients receive the pain treatment they need. It is easier to follow the medication safety advice of your provider when you are not preoccupied with concerns about your next meal or where you lay your head to sleep.

In my over 20 years of emergency care experience, I have dealt with many cases in which adopting a holistic perspective has helped me deliver more effective care. I ask patients if they have access to food, a bed or a shower. When it comes to chronic pain, I ask these individuals whether they have a regular provider to follow up on their pain management treatment. These are all factors I consider in the process of providing the best quality care to my patients.

PAs across the country can also ensure the proper treatment of pain for their patients by knowing their state laws and regulations and advocating for the breakdown of barriers to access. In addition to making sure patients understand their rights, risks and responsibilities, PAs have a duty to help individuals in their care know about the safe use, storage and disposal of prescription opioids. PAs should also ask the patient about how their life circumstances may affect their ability to follow through on treatment plans. Being familiar with local services like shelters and free transportation options can help ease stress in a patient’s life and allow them more space to follow a treatment plan successfully to ensure the best healthcare outcomes. This may include considering alternatives to opioids for pain treatment, as patients can feel empowered to live healthy lives without the need for opioids.

For help in building trust with patients and tips on how to promote education about safe prescription opioid use within all patient populations, visit AAOA’s website. Additionally, PA students can take the Pledge to Pause to commit to talking with their future patients about the rights, risks and responsibilities associated with prescription opioids.