As a pain management specialist, I think the biggest pain reporting co-variate that needs to be explained in this study is the disability percentage in the author's sample. That is, it needs to be considered that a large percentage of persons receiving, or applying for some form of disability related to pain are known to have severe subjective complaints of pain when there are few actual medical findings. Not to diminish the reality of the pain-disability correlation in many individuals, it is well established that persons seeking to obtain or maintain financial compensation based on a pain related medical disability can be influenced by secondary gain issues, including malingering to get a social security check. There is also the issue of persons with high levels of subjectively reported pain but with few medical findings abusing or diverting medications used to otherwise control legitimate, organically based pain complaints.
My major concern is that we should not be quick to turn survey data into justification for a "medical problem in the poor" that is not being addressed by the health care system. First, it needs to be ruled out that for many of the respondents, this very well may be an economic or social problem involving obtaining disability or misusing prescribed substances, and not a case of under-serving a medical population.
The medical system cannot fix vocational problems, economic problems, or drug abuse/psychiatric issues by prescribing more pain medications; this is the main take home message of my comment(s). In fact, prescribing these medications may only foster more crime and related social issues in socially vulnerable individuals and their families.
Having not read the exact content of the study, I would like to hear some clarifications of the study details by the author of this article. So, take the above comments as a caveat until this additional data is provided. But remember, things are not always what they seem on the surface, and correlation is not always causation.
John G.of NC8:28PM June 30, 2012
Dr Green and her colleagues have failed to come up with an energetic vision for people in pain- sh has failed to call for strict rule of law for a pain bill of rights- she doesnt want her colleagues in medicine to be held accountable for the inhumane pain care they rovide. Its a terrible thing to see without a vison- like most medical professionals Dr Green has failed to develop a vision for people in pain.
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John G. of NC 8:28PM June 30, 2012
dave of NY 4:30PM March 08, 2012