Analgesic, chronic pain, disparities, equity, health disparities, implicit bias, nonopioid, nurse practitioner, opioid, primary care, veterans, workforce



  1. Nikpour, Jacqueline PhD, RN (Postdoctoral Fellow)


Background: Evidence exists on racial and gender disparities in chronic pain management among veterans. Most literature has described physicians' disparate opioid prescribing patterns, although it is unknown if prescribing disparities exist among nurse practitioners (NPs) and physician assistants (PAs) or among prescription of nonopioid analgesic strategies.


Purpose: To identify patient characteristics associated with opioid and nonopioid prescriptions among Veterans Affairs (VA) chronic pain patients by primary care physicians, NPs, and PAs.


Methodology: We used data from the VA's Survey of Health care Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Outcomes included opioid and nonopioid analgesic prescriptions. Patient characteristics included race/ethnicity, gender, education level, age, and clinical characteristics (comorbidities, self-reported health, and self-reported mental health). Logistic regression was performed to test for associations of patient characteristics with outcomes.


Results: Patients who were White, male, age 41-64 years, and with no postsecondary education had higher odds of receiving an opioid prescription (all p-values <= .01), whereas patients who were Black, female, and <65 years old had higher odds of a nonopioid prescription (all p-values < .01). Having 5+ comorbidities and fair/poor self-reported health increased the odds of opioid and nonopioid prescriptions (all p-values < .01).


Conclusions: Disparities in race, gender, and educational level significantly affect how primary care NPs, PAs, and physicians manage chronic pain.


Implications: NPs and other primary care providers should pursue training opportunities to identify and mitigate potential biases that may affect their practice. Future research should take an intersectional lens in examining the source of chronic pain disparities.