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A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform

No Access, No Relief

Don Dillard’s pelvis was crushed on April 5, 1991 when a truck ran over him at a Detroit recycling plant where he worked at the time. With multiple fractures, the accident changed his life. He was flown to nearest trauma center, spent 40 days in the hospital and was released in a wheelchair—and in agony.

He spent 10 years undergoing operations, including extensive orthopedic and plastic surgery, and grueling physical therapy that enabled him to walk again. But he was in pain and couldn’t sleep. Doctors never prescribed anything more than non-steroidal anti-inflammatory medicines, even though these drugs provided little or no relief. Dillard, who had always been an extremely active person, could no longer work. He struggled with clinical depression and fought to get reimbursements from his insurance company for thousands of dollars in medical expenses.

“Everything about my life had been decimated,” he says.

His family and his faith pulled him through that dark period. He finally received a referral to a pain medicine specialist, and a decade after his accident, Dillard got a prescription for a medicine strong enough to handle his severe pain.

It is impossible to know whether the inadequate care received by Dillard—who is African American—was influenced by race. However, extensive studies show that minorities are less likely than whites to receive adequate assessment and treatment for their pain, a disparity that puts minorities at risk for untreated pain, says Carmen Green, MD, at the University of Michigan in Ann Arbor where Dillard was treated.

Some physicians aren’t trained to handle strong pain medications. And in some cases, physicians fear that patients will misuse the drugs and that fear can override all other judgments, Green says.

Even after Dillard was given an opportunity to try a strong opioid, and it worked, he faced another barrier, one that disproportionately affects minorities. He had trouble filling prescriptions because pharmacies in his area didn’t stock medications that are often the target of break-ins. He traveled two hours by car in order to fill his prescriptions in a nearby city.

“I was in excruciating pain during those trips,” he says about the ordeal.

But, the stronger medicine eases the pain, allows him to sleep at night, and makes it possible for him to do more around his home, like helping to care for his two-year old grandson and getting yard work done. “It might take me all day, but I can do it,” he says.

He is just happy to have his life back.