Increasing Equity in Pain Management, Substance Use Disorder Treatment, and Linkages to CARE

PATIENT PERSONA: Darren

Darren is a married 49-year-old Black man, and a former athlete. Nine years ago, Darren felt a sharp pain in his back while showering. He fell and could not get up. At the emergency room, Darren was told that he had strained his back and would be discharged. But Darren and his family members convinced the hospital to admit him. An orthopedist determined that Darren had a severe disc herniation with spinal cord compression and needed immediate surgery. After multiple lumbar surgeries and 6 months of hospitalization, Darren lost his job as a security guard and thus his health insurance. He began to receive his medical care at a local health center. With assistance from the health center’s Medical-Legal Partnership, Darren applied for and received disability insurance. He was referred to a pain management specialist and was put on multiple opioids in addition to muscle relaxers and gabapentin, due to his high level of pain. Family members began to worry that Darren was becoming addicted to pain medications. In addition, Darren was becoming depressed because he could no longer be as active as he was in the past. At the suggestion of his primary care provider, Darren began receiving counseling from a clinical social worker at the health center. Darren’s counselor referred him to the health center’s new Integrative Pain Management Program. He began attending their peer support groups, where he has learned about nutrition, mind-body strategies, and gentle yoga. Darren also started regular acupuncture at the clinic. Darren now reports his pain is much better and he no longer uses opioids. Darren also joined the health center’s governing board, and uses board membership to maintain support for the Integrative Pain Management Program.

Reflections and questions

■ What are Darren’s intersecting identities and lived experiences? ■ How can Darren’s intersecting identities help the care team see him as a whole person? ■ What systemic and structural inequities did Darren encounter when seeking treatment for his pain? ■ How might these inequities have affected Darren’s trust in, and engagement with, the healthcare system? ■ Who at the health center became involved in Darren’s care, and how did this involvement contribute to improving Darren’s health? ■ What attributes of the health center contributed to Darren’s improved mental and physical health?

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