This episode features Dr. Amber Brooks, a board certified anesthesiologist and comprehensive pain management physician. This episode examines the management of acute and chronic pain, focuses on bias that can manifest in treating those with chronic pain and how physicians can address disparities in people and communities facing barriers to adequate care.  

Get CME credit for listening to the episode here

Learning Objectives
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      1.  Define Acute Pain and Chronic Pain 
      2. Describe different biases that can manifest in treating those with chronic pain 
      3. Summarize some of the ways we can address disparities in groups that have been historically marginalized, such as those with limited English proficiency and Sickle Cell Disease 
      4. Explain how a mobile phone intervention can be used to address disparities in populations with limited transportation 
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Show Notes
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[00:00-00:46] Disclaimer
  • Before we start, we clarify what is meant by the term provider our guest use in this episode 
  • We at The DEI Shift endorse and support the use of term physician in place of provider as applicable
  • For more information, please refer to the article below 

 [00:47-01:54] Introduction 
[02:09-03:14] Introduction to Guest
  • Dr. Amber K. Brooks, a board certified anesthesiologist and comprehensive pain management physician
 

[03:15-05:14 Step in Your Shoes 
  • Dr. Brooks shares about her travel experience to Addis Ababa, Ethiopia which sparked her interest in addressing disparities in pain management
 
[05:24-06:16] Definition of Acute Pain and Chronic Pain
  • Dr. Brooks defines acute pain and chronic pain
    • Acute pain: associated with trauma, surgery, etc. Usually lasts a few weeks but  less than 3 to 6 months 
    • ​Chronic pain: pain that extends beyond the normal tissue healing process, usually greater than 3 to 6 months and is present on most days 
  • Learn more about the continuum of pain through ACP Pain Management Curriculum, Module 1
 
[06:17-12:02 Common Bias Seen in Pain Management 
  • Because of the subjective nature of pain, it is common for bias to form towards patients with chronic pain 
  • In trainees, a common way unconscious bias presents is calling someone a “challenging patient,” which is often learned through the hidden curriculum 
  • ​This can also be called confirmation bias, where we interpret data and information based on our own beliefs. It is important we leave room for the patient to tell their story so we minimize bias. 
  • Bias can also be transmitted through the Electronic Medical Record, so we should be mindful of how we describe patients in our notes 
  • ​Candace references an article from 2015 where medical students held misconstrued facts about black patients, such as higher threshold for pain and thicker skin
  • We must hold each other accountable about our implicit bias as this is the only way to recognize our own biases and properly address them 
 
[12:45-20:58] Multimodal Approach to Chronic Pain 
  • A multimodal approach to chronic pain is critical as it address pain from multiple angles, including sleep, mood and physical activity 
  • Use of non-opiate medications that target both pain and mood, physical therapy and referral to a pain specialist are some examples of a multimodal strategy. 
  • ​It is crucial that we spend time listening, establish rapport, trust, and expressing empathy towards our patient’s experience as this helps strengthen the patient-doctor relationship in  groups placed at increased risk of disparities​
 
[20:59-23:28] Disparities Seen in Patients with Chronic Pain  
[23:29-25:45] Ways Disparities Manifest for Marginalized Patients whose English is not Their First Language   
[25:46-32:41] Addressing Disparities Seen in Those with Sickle Cell Disease
  • It is vital that we increase communication between the hematologist, inpatient physicians and other members of the care team 
  • Dr. Brooks implemented a care plan for patients suffering with an acute sickle cell pain crisis which decreased hospital length of stay and readmission rates 
  • We must be mindful that patients express their pain in different ways. Someone may appear ‘comfortable’ but could be experiencing severe pain. One of the largest pitfalls is not listening to patients and letting them tell you their experiences of what works and what doesn’t work for them. 
  • Asking open-ended questions is essential. Students and trainees may be in the best position to spend time and present a more complete story from the patient’s perspective
 
[32:42-36:24]  Steps We Can Take to Dismantle Bias Towards Patients with Chronic Pain
  • Hold each other accountable towards addressing each others bias and be open if you are on the receiving end of that feedback 
  • Step outside of your comfort zone and experience something outside of your lived experience can help you better relate to patients
  • If you are at an institution that may lack resources, advocate for those resources by referencing known evidence based interventions  including how they can improve cost and outcomes 
 
[36:29-39:51] How Mobile Phone Interventions Can Address Disparities 
  • Dr. Brooks shares with us one of her mobile phone interventions to help address disparities in geriatric patients with obesity suffering from chronic pain 
  • Here is another mobile phone intervention that her group implemented 
  • Given the recent pivot towards tele-medicine, these interventions are timely and can help address and decrease these disparities
 
[39:52-42:38] Take Home Points from Dr. Brooks 
  • All of us have an obligation to our patients and to one another to call each other out respectfully when something is not right 
  • Important to listen to our patient and let them share their lived experiences 
  • Dr. Brooks also references an educational series on teaching pain management and bias to trainees 
 
[42:39-43:55] Closing  
Course Director and Senior Producer: Dr. Dirk Gaines
Co-Hosts: Dr. Dirk Gaines and Dr. Candace Sprott
Guest: Dr. Amber Brooks
Production Assistants: Alex Babkanian, Clara Baek


Special thanks to  Dr. Tammy Lin, Dr. Tiffany Leung, Dr. Pooja Jaeel, Dr. Maggie Kozman, Alex Babakanian, Clara Baek, Likitha Aradhyula, Cheryl Ruston, Clare Sipler, and Dr. Davoren Chick for helping to make this project possible.





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.The DEI Shift podcast and its guests provide general information and entertainment, but not medical advice. Before making any changes to your medical treatment or execution of your treatment plan, please consult with your doctor or personal medical team. Reference to any specific product or entity does not constitute an endorsement or recommendation by The DEI Shift. The views expressed by guests are their own, and their appearance on the podcast does not imply an endorsement of them or any entity they represent. Views and opinions expressed by The DEI Shift team are those of each individual, and do not necessarily reflect the views or opinions of The DEI Shift team and its guests, employers, sponsors, or organizations we are affiliated with.