Bias in Musculoskeletal Pain Management and Bias-Targeted Interventions to Improve Pain Outcomes: A Scoping Review.
Bright Eze, Sumanya Kumar, Yuxuan Yang and 3 others
PMID 35358134WHAT IT FOUND
Bias and discrimination were linked to worse pain, disability and less pain treatment for patients with musculoskeletal pain.
Perspective-taking reduced provider bias in a reviewed study, but interventions had mixed effects and did not consistently improve pain outcomes.
Key findings
01Reviewed studies reported that discrimination and perceived injustice were associated with worse pain, disability, depression, and lower quality of life, and that Black and Hispanic patients were less likely to have pain behaviors documented or receive analgesics.
02In a reviewed study, providers who received a tailored virtual perspective-taking intervention had 85% lower odds of treatment bias toward Black patients and 76% lower odds of treatment bias toward low socioeconomic status patients.
03Bias-targeted interventions were mixed: a total knee replacement decision aid increased patients' decision to undergo surgery but did not change provider recommendations, and an emergency department opioid information intervention was associated with lower odds of Black patients being discharged with an opioid.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The review is a scoping review, so it maps the literature rather than combining results into a single effect. Studies were kept if they scored above 60% on quality appraisal, which includes moderate quality concerns. All included studies were conducted in the United States, so the findings may not transfer elsewhere. Most studies focused on low back or knee pain, with few in other musculoskeletal pain conditions or comorbid pain. No included studies used intersectional theory to examine multiple identity layers together. No included studies evaluated organizational or system-level bias interventions.
The easy way to misread this
Do not read the 85% lower odds of treatment bias after perspective-taking as proof that this training reduces patient pain. It measured provider bias in a reviewed study, and the review did not show a consistent effect on musculoskeletal pain outcomes.