Ethnic Differences in Pain Among Outpatients with Terminal and End-Stage Chronic Illness


Michael W. Rabow, MD, UCSF/Mount Zion, 1701 Divisadero Street, Fifth Floor, San Francisco, CA 94115, USA. Tel: 415-353-7918; Fax: 415-353-7932; E-mail:


Objective.  To explore ethnic and country of origin differences in pain among outpatients with terminal and end-stage chronic illness.

Design.  Cohort study within a year-long trial of a palliative care consultation.

Setting.  Outpatient general medicine practice in an academic medical center.

Patients.  Ninety patients with advanced congestive heart failure, chronic obstructive pulmonary disease, or cancer, and with a prognosis between 1 and 5 years.

Outcome Measures.  Patients’ report of pain using the Brief Pain Inventory and analgesic medications prescribed by primary care physicians. Differences in pain report and treatment were assessed at study entry, at 6 and 12 months.

Results.  The overall burden of pain was high. Patients of color reported more pain than white patients, including measures of least pain (P = 0.02), average pain (P = 0.05), and current pain (P = 0.03). No significant ethnic group differences in pain were found comparing Asian, black, and Latino patients. Although nearly all patients who were offered opioid analgesics reported using them, opioids were rarely prescribed to any patient. There were no differences in pain between patients born in the U.S. and immigrants.

Conclusions.  Pain is common among outpatients with both terminal and end-stage chronic illness. There do not appear to be any differences in pain with regard to country of origin, but patients of color report more pain than white patients. Patients of all ethnicities are inadequately treated for their pain, and further study is warranted to explore the relative patient and physician contributions to the finding of unequal symptom burden and inadequate treatment effort.