{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:01:21Z","timestamp":1788447681634,"version":"build-2803163510"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T00:00:00Z","timestamp":1683590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The present Program Evaluation study examines sociodemographic characteristics of Veterans in the Phoenix VA Health Care System who have back pain, and specifically the likelihood of those characteristics being associated with a referral to the Chronic Pain Wellness Center (CPWC) in the year 2021. We examined the following characteristics: Race\/ethnicity, gender, age, mental health diagnosis, substance use disorder diagnosis, and service-connected diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Our study used cross sectional data from the Corporate Data Warehouse for 2021. 13624 records had complete data for the variables of interest. Univariate and multivariate logistic regression was used to determine the likelihood of patients' being referred to the Chronic Pain Wellness Center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The multivariate model found under-referral to be significant for younger adults and for patients who identified as Hispanic\/Latinx, Black\/African American, or Native American\/Alaskan. Those with depressive disorders and opioid use disorders, on the other hand, were found to be more likely to be referred to the pain clinic. Other sociodemographic characteristics were not found to be significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Study limitations include the use of cross-sectional data, which cannot determine causality, and the inclusion of patients only if the ICD-10 codes of interest were recorded for an encounter in 2021 (i.e., a prior history of a particular diagnosis was not captured). In future efforts, we plan to examine, implement, and track the impact of interventions designed to mitigate these identified disparities in access to chronic pain specialty care.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpain.2023.1110554","type":"journal-article","created":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T19:03:32Z","timestamp":1683659012000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Program Evaluation: exploring health disparities that impact chronic pain referrals within a VA Health Care System"],"prefix":"10.3389","volume":"4","author":[{"given":"Eric R.","family":"Hanson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi E.","family":"Quist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Mintert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahreen","family":"Arshad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany L.","family":"Friedman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Pleasant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. Stacey","family":"Monico-Cristales","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhonda","family":"Tillman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Mehelis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Karnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anais","family":"Sonder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aram S.","family":"Mardian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,9]]},"reference":[{"key":"B1","year":"2021"},{"key":"B2","author":"Ndugga","year":""},{"key":"B3","year":""},{"key":"B4","doi-asserted-by":"publisher","first-page":"606","DOI":"10.3390\/ijerph16040606","article-title":"Reducing racial inequities in health: using what we already know to take action","volume":"16","author":"Williams","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.1111\/j.1475-6773.2012.01387.x","article-title":"Measuring racial\/ethnic disparities in health care: methods and practical issues","volume":"47","author":"Cook","year":"2012","journal-title":"Health Serv Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.ijmedinf.2017.09.014","article-title":"Examining health disparities by gender: a multimorbidity network analysis of electronic medical record","volume":"108","author":"Kalgotra","year":"2017","journal-title":"Int J Med Inform"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/2378023119831801","article-title":"Where\u2019s the beef? How masculinity exacerbates gender disparities in health behaviors","volume":"5","author":"Nakagawa","year":"2019","journal-title":"Socius"},{"key":"B8","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/S0140-6736(16)00683-8","article-title":"Transgender people: health at the margins of society","volume":"388","author":"Winter","year":"2016","journal-title":"Lancet"},{"key":"B9","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1093\/geront\/gnu158","article-title":"Ageism as a risk factor for chronic disease","volume":"56","author":"Allen","year":"2016","journal-title":"Gerontologist"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.1016\/S0140-6736(21)00524-9","article-title":"Ageism: a social determinant of health that has come of age","volume":"397","author":"Mikton","year":"2021","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","first-page":"175","DOI":"10.9740\/mhc.2021.05.175","article-title":"Depression-related stigma among primary care providers","volume":"11","author":"Kluemper","year":"2021","journal-title":"Ment Health Clin"},{"key":"B12","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1177\/1359786810382058","article-title":"Inequalities in healthcare provision for people with severe mental illness","volume":"24","author":"Lawrence","year":"2010","journal-title":"J Psychopharmacol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"133","DOI":"10.3109\/14659891.2014.980860","article-title":"Inequalities in healthcare provision for individuals with substance use disorders: perspectives from healthcare professionals and clients","volume":"21","author":"van Boekel","year":"2016","journal-title":"J Subst Use"},{"key":"B14","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1111\/j.1526-4637.2011.01310.x","article-title":"Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States","volume":"13","author":"Meghani","year":"2012","journal-title":"Pain Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1046\/j.1526-4637.2003.03034.x","article-title":"The unequal burden of pain: confronting racial and ethnic disparities in pain","volume":"4","author":"Green","year":"2003","journal-title":"Pain Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1016\/j.jpain.2009.10.002","article-title":"Racial and ethnic disparities in pain: causes and consequences of unequal care","volume":"10","author":"Anderson","year":"2009","journal-title":"J Pain"},{"key":"B17","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1353\/hpu.0.0255","article-title":"Race, ethnicity, and pain among the U.S. adult population","volume":"21","author":"Shavers","year":"2010","journal-title":"J Health Care Poor Underserved"},{"key":"B18","doi-asserted-by":"publisher","first-page":"100101","DOI":"10.1016\/j.ynpai.2022.100101","article-title":"The neurobiology of social stress resulting from racism: implications for pain disparities among racialized minorities","volume":"12","author":"Hobson","year":"2022","journal-title":"Neurobiol Pain"},{"key":"B19","doi-asserted-by":"publisher","first-page":"6358624","DOI":"10.1155\/2018\/6358624","article-title":"\u201cBrave men\u201d and \u201cemotional women\u201d: a theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain","volume":"2018","author":"Samulowitz","year":"2018","journal-title":"Pain Res Manag"},{"key":"B20","doi-asserted-by":"publisher","first-page":"S26","DOI":"10.1016\/j.pain.2007.10.014","article-title":"Studying sex and gender differences in pain and analgesia: a consensus report","volume":"132","author":"Greenspan","year":"2007","journal-title":"Pain"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2217\/17455057.5.1.79","article-title":"Gender differences and pain medication","volume":"5","author":"Richardson","year":"2009","journal-title":"Women\u2019s Health"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1111\/head.14171","article-title":"\u202fHeadache in transgender and gender-diverse patients: a narrative review","volume":"61","author":"Hranilovich","year":"2021","journal-title":"Headache"},{"key":"B23","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1007\/s13669-020-00293-x","article-title":"Pelvic pain in the transgender man","volume":"9","author":"Moulder","year":"2020","journal-title":"Curr Obstet Gynecol Rep"},{"key":"B24","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.psychres.2014.04.028","article-title":"Mental health stigma and primary health care decisions","volume":"218","author":"Corrigan","year":"2014","journal-title":"Psychiatry Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.1080\/13607863.2018.1481922","article-title":"Mental health disorder, pain, and pain treatment among long-term care residents: evidence from the minimum data set 3.0","volume":"23","author":"Brennan","year":"2019","journal-title":"Aging Ment Health"},{"key":"B26","year":""},{"key":"B27","year":""},{"key":"B28","doi-asserted-by":"publisher","first-page":"806310","DOI":"10.3389\/fpain.2021.806310","article-title":"Sociodemographic differences in pain medication usage and healthcare provider utilization among adults with chronic low back pain","volume":"2","author":"Allen-Watts","year":"2022","journal-title":"Front Pain Res (Lausanne)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1080\/15360288.2022.2154884","article-title":"Equity reporting in systematic reviews of opioid treatment of chronic non-cancer pain with patient-reported outcomes","volume":"37","author":"Landers","year":"2023","journal-title":"J Pain Palliat Care Pharmacother"},{"key":"B30","doi-asserted-by":"publisher","first-page":"h532","DOI":"10.1136\/bmj.h532","article-title":"Management of chronic pain in older adults","volume":"350","author":"Reid","year":"2015","journal-title":"Br Med J"},{"key":"B31","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1136\/bjsports-2018-099671","article-title":"The lancet series on low back pain: reflections and clinical implications","volume":"53","author":"O'Sullivan","year":"2019","journal-title":"Br J Sports Med"},{"key":"B32","volume-title":"Diagnostic and statistical manual of mental disorders","year":"2022"},{"key":"B33","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1097\/SMJ.0b013e3181e74ede","article-title":"Pain management by primary care physicians, pain physicians, chiropractors, and acupuncturists: a national survey","volume":"103","author":"Breuer","year":"2010","journal-title":"South Med J"},{"key":"B34","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s12877-015-0042-z","article-title":"\u202fAgeism, negative attitudes, and competing co-morbidities\u2014why older adults may not seek care for restricting back pain: a qualitative study","volume":"15","author":"Makris","year":"2015","journal-title":"BMC Geriatr"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e105450","DOI":"10.1371\/journal.pone.0105450","article-title":"\u201cI try and smile, I try and be cheery, I try not to be pushy. I try to say \u2018i'm here for help\u2019 but I leave feeling\u2026 worried\u201d: a qualitative study of perceptions of interactions with health professionals by community-based older adults with chronic pain","volume":"9","author":"Clarke","year":"2014","journal-title":"PLoS One"},{"key":"B36","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1111\/j.1365-2702.2004.01047.x","article-title":"A literature review exploring how healthcare professionals contribute to the assessment and control of postoperative pain in older people","volume":"13","author":"Brown","year":"2004","journal-title":"J Clin Nurs"},{"key":"B37","doi-asserted-by":"publisher","first-page":"S30","DOI":"10.1093\/pm\/pny094","article-title":"Project STEP: implementing the veterans health administration's stepped care model of pain management","volume":"19","author":"Edmond","year":"2018","journal-title":"Pain Med"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1168","DOI":"10.1093\/pm\/pnz336","article-title":"Flipping the pain care model: a sociopsychobiological approach to high-value chronic pain care","volume":"21","author":"Mardian","year":"2020","journal-title":"Pain Med"},{"key":"B39","first-page":"37","article-title":"Supercharge your pain biology","volume-title":"Explain pain supercharged","author":"Moseley","year":"2017"},{"key":"B40","first-page":"4","article-title":"The Arizona pain and addiction curriculum faculty guide","author":"Mardian","year":"2018","journal-title":"Component"},{"key":"B41","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1177\/0033354920954505","article-title":"Redefining pain and addiction: creation of a statewide curriculum","volume":"135","author":"Villarroel","year":"2020","journal-title":"Public Health Rep"},{"key":"B42","author":"Gradus","year":""},{"key":"B43","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1089\/jwh.2020.8732","article-title":"Baseline characteristics from the women veterans cohort study: gender differences and similarities in health and healthcare utilization","volume":"30","author":"Gaffey","year":"2021","journal-title":"J Womens Health (Larchmt)"},{"key":"B44","doi-asserted-by":"publisher","first-page":"usac134","DOI":"10.1093\/milmed\/usac134","article-title":"The lived experience of military women with chronic pain: a phenomenological study","author":"Peppard","year":"2022","journal-title":"Mil Med"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1093\/tbm\/ibz200","article-title":"A systematic review of stigma in sexual and gender minority health interventions","volume":"10","author":"Layland","year":"2020","journal-title":"Transl Behav Med"},{"key":"B46","year":""},{"key":"B47","doi-asserted-by":"publisher","first-page":"T70","DOI":"10.1016\/j.jpain.2016.01.001","article-title":"The role of psychosocial processes in the development and maintenance of chronic pain","volume":"17","author":"Edwards","year":"2016","journal-title":"J Pain"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1620","DOI":"10.1111\/j.1475-6773.2005.00444.x","article-title":"Measuring diagnoses: ICD code accuracy","volume":"40","author":"O'Malley","year":"2005","journal-title":"Health Serv Res"},{"key":"B49","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1097\/ACM.0000000000003173","article-title":"Implicit bias in health professions: from recognition to transformation","volume":"95","author":"Sukhera","year":"2020","journal-title":"Acad Med"},{"key":"B50","doi-asserted-by":"publisher","first-page":"S74","DOI":"10.1097\/ACM.0000000000002386","article-title":"How to make or break implicit bias instruction: implications for curriculum development","volume":"93","author":"Gonzalez","year":"2018","journal-title":"Acad Med"},{"key":"B51","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s40359-019-0299-7","article-title":"\u202fInterventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: a systematic review","volume":"7","author":"FitzGerald","year":"2019","journal-title":"BMC Psychol"}],"container-title":["Frontiers in Pain Research"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2023.1110554\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T19:03:37Z","timestamp":1683659017000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2023.1110554\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,9]]},"references-count":51,"alternative-id":["10.3389\/fpain.2023.1110554"],"URL":"https:\/\/doi.org\/10.3389\/fpain.2023.1110554","relation":{},"ISSN":["2673-561X"],"issn-type":[{"value":"2673-561X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,9]]},"article-number":"1110554"}}