key: cord-0991495-oey65ekg authors: Abd-Elsayed, Alaa; Heyer, Ann M; Schatman, Michael E title: Disparities in the Treatment of the LGBTQ Population in Chronic Pain Management date: 2021-11-30 journal: J Pain Res DOI: 10.2147/jpr.s348525 sha: 07a316208927b685087aac1032fff7d28714c2a8 doc_id: 991495 cord_uid: oey65ekg nan a population with high levels of chronic pain, worse outcomes, and unique challenges in treating them. The LGBTQ population faces challenges in access to healthcare. A larger portion of LGBTQ individuals lack access to health insurance and live in poverty than is the case in the general population. 17 LGBTQ individuals are more likely to delay medical care or forgo it entirely. 18 Reasons for avoiding healthcare include discrimination from health care providers and even denial of care. 19, 20 A 2015 study found that 33% of transgender individuals reported one or more negative experiences related to being transgender such as being refused treatment, being harassed or assaulted, or receiving incompetent care. 21 Discrimination and receiving incompetent care are reasonable fears. Bias and lack of education of this population is common among healthcare providers. A study of medical students demonstrated that approximately half of the students reported having negative attitudes toward lesbian and gay people. 22 Additionally, most medical schools and residency programs do not educate sufficiently on LGBTQ healthcare. In American and Canadian medical schools, an average of only 5 hours is spent on LGBTQ-specific content; many reported no such education at all. 23 Education and cultural competency can improve outcomes for the LGBTQ population. 24 A history of discrimination leading to socioeconomic challenges has led to barriers to utilizing healthcare which have created worse health outcomes. This population deserves better care, and it is our responsibility as providers to work to educate ourselves and examine possible biases we have that are contributing to barriers in care. Unique and unfortunate socioeconomic stressors have led to high amounts of comorbid mental health disorders and chronic pain in the LGBTQ population. This population is more likely than their heterosexual counterparts to report chronic pain in multiple sites causing functional limitations. Comorbidity with mental health disorders leads to worse prognoses in the treatment of chronic pain and more interference with relationships and activities or daily life. Therefore, special attention should be paid to the care of these patients and efforts should be made to improve access to care. Provider education and dedication to improving cultural competency are measures that the medical community can take to help this population gain confidence in utilizing healthcare. Additionally, improving access to health insurance remains a necessary step. Through acknowledging the unique challenges and health problems of the LGBTQ, we can strive to better treat chronic pain and improve the quality of life of all of our patients. Our failure to do so would represent a violation of the bioethical principle of justice, and as the number of people acknowledging LGBTQ identification continues to increase, we can hardly afford to do so. Dr Michael E Schatman serves as a research consultant for Modoscript. The authors report no other conflicts of interest in this work. identification rises to 5.6% in latest U.S. estimate; 2021 Chronic Health Conditions and Key Health Indicators Among Lesbian, Gay, and Bisexual Older US Adults Sexual orientation, health risk factors, and physical functioning in the Nurses' health study II Factors Associated with Sexual Orientation and Gender Disparities in Chronic Pain Among U.S. Adolescents and Young Adults Pain as a symptom in depressive disorders. II. relationship to personality traits as assessed by means of KSP Frequency of painful physical symptoms with major depressive disorder in Asia: relationship with disease severity and quality of life Pain as a symptom of depression: prevalence and clinical correlates in patients attending psychiatric clinics A cross-national study of the course of persistent pain in primary care Depression as a risk factor for onset of an episode of troublesome neck and low back pain Impact of pain on depression treatment response in primary care Clinical aspects of depression in chronic pain patients Chronic pain and major depressive disorder in the general population Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents. Safren S, Heimberg R Mental health and quality of life of gay men and lesbians in England and Wales: a controlled, cross-sectional study Prejudice, social stress and mental health in lesbian, gay and bisexual populations: conceptual issues and research evidence The lives and livelihoods of many in the LGBTQ community are at risk amidst COVID-19 crisis How to close the LGBT health disparities gap National Transgender Discrimination Survey Report on Health and Health Care. Washington DC: National Center for Transgender Equality and National Gay and Lesbian Task Force Factors associated with health care discrimination experiences among a National Sample of female-to-male transgender individuals The Report of the 2015 U.S. Transgender Survey: Executive Summary Do contact and empathy mitigate Bias against gay and lesbian people among heterosexual first-year medical students? A report from the medical student CHANGE study Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education Barriers and Facilitators to Cancer Screening Among LGBTQ Individuals With Cancer