Inequitable access to nonpharmacologic pain treatment providers among cancer-free U.S. adults

Objective: Using evidence-based nonpharmacologic pain treatments may prevent opioid overuse and associated adverse outcomes. There is limited data on the impact of access-promoting social determinants of health (SDoH: education, income, transportation) on use of nonpharmacologic pain treatments. Our objective was to examine the relationship between SDoH and use of nonpharmacologic pain treatment providers. Our goal was to understand policy-actionable factors contributing to inequity in pain treatment. Methods: Based on Andersen's Health Utilization Model, this cross-sectional analysis of 2016–2019 Medical Expenditure Panel Survey data evaluated whether use of outpatient nonpharmacologic pain treatment providers is driven by enabling (i.e., advantageous socioeconomic resources) or need (i.e., perceived disability and diagnosed disease) factors. The study sample (unweighted n = 28,188) represented a weighted N = 81,912,730 noninstitutionalized, cancer-free, U.S. adults with pain interference. The primary outcome measured use of nonpharmacologic providers relative to exclusive prescription opioid use or no treatment (i.e., neither opioids nor nonpharmacologic). To quantify equitable access, we compared the variance—between access-promoting enabling factors versus medical need factors—that explained utilization. Results: Compared to enabling factors, need factors explained twice the variance predicting pain treatment utilization. Still, the adjusted odds of using nonpharmacologic providers instead of opioids alone were 39% lower among respondents identifying as Black (95% Confidence Interval [CI], 0.49–0.76) and respondents residing in the U.S. South (95% CI, 0.51–0.74). Higher education (95% CI, 1.72–2.79) and income (95% CI, 1.68–2.42) both facilitated using nonpharmacologic providers instead of opioids. Conclusions: These findings highlight the substantial influence access-promoting SDoH have on pain treatment utilization.