Racial/Ethnic and Sex Differences in Coping Mechanisms and Barriers to Health Care Among Adults with Chronic Pain: North Carolina, 2018-2019

BACKGROUND Individuals with chronic pain often turn to the health care system for treatment and pain management strategies, but barriers to health care access can make this difficult. METHODS We analyzed data from the 2018 and 2019 North Carolina Behavioral Risk Factor Surveillance System (NC BRFSS) surveys to understand whether coping mechanisms for chronic pain differed by specific health care barriers, sex, and race/ethnicity. We assessed 4 health care barriers: coverage barrier (no health insurance), provider barrier (no personal doctor/provider), cost barrier (not seeing a doctor in the past year due to cost), and checkup barrier (no checkup in the past 2 years). RESULTS Compared to individuals with no health care barriers, individuals with any health care barrier used coping mechanisms tied to the health care system (e.g., prescription drugs and non-medication pain therapies) less frequently. Differences were also observed by sex and race/ethnicity. Among individuals with or without barriers, men reported using alcohol and marijuana or other street drugs to cope more frequently than women, while women used prescription medications more frequently than men. Among individuals with at least one barrier, Black, non-Hispanic individuals reported using prescription drugs and non-medication pain therapies less frequently than White, non-Hispanic individuals. LIMITATIONS The response rate for the NC BRFSS surveys was low, though adjusted for by weighting. We were limited by the available categories for coping mechanisms, and we restricted race/ethnicity analyses to White, non-Hispanic and Black, non-Hispanic individuals. CONCLUSIONS Our findings indicate that differences in the use of prescription and non-prescription pain therapies by race/ethnicity for individuals with chronic pain may also be interconnected with health care access barriers.