The Journal of the American Medical Association – Network Open has published findings from a recent University of North Texas Health Science Center study about chronic lower back pain, race and the patient-physician relationship.

The study revealed that Black patients reported worse outcomes for low back pain intensity and back-related disability compared with white patients. However, none of these racial differences in chronic pain outcomes was attributable to any aspect of the patient-physician relationship.

The study was conducted by the team at the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation, known as PRECISION Pain Research Registry, led by Dr. John Licciardone at The University of North Texas Health Science Center at Fort Worth. The article, “Analysis of the Patient-Physician Relationship, Race, and Pain Control and Physical Function Among Adults with Chronic Low Back Pain,” was published in the June issue of the journal.

“This work addresses questions about race and the patient-physician relationship that were raised almost 50 years ago by former U.S. Surgeon General, David Satcher, MD,” said Licciardone, executive director of the Osteopathic Research Center and regents professor at HSC’s Texas College of Osteopathic Medicine. “Our team looked closely at physician communication, physician empathy and patient satisfaction with their medical care to determine if these aspects of the patient-physician relationship could explain the worse pain outcomes experienced by Black patients. However, we did not find any link between the patient-physician relationship and pain outcomes.”

The study, conducted by investigators at HSC’s Osteopathic Research Center, included Licciardone and student doctors Sweta Ganta, Leah Goehring, Kendall Wallace and Ryan Pu. The student doctors participated in the research as part of a clinical research fellowship program affiliated with the ORC’s PRECISION Pain Research Registry.

“Research is how we progress. It’s how we continue to push the envelope to create more advanced, safer medical care,” Wallace said. “This experience also reiterated for me the concept of teamwork as I was working with three other medical students under the direction of Dr. Licciardone. Everyone had a part to play, distinct from each other, but just as meaningful as the next.”

The research team examined 1,177 participants of the PRECISION Pain Research Registry, which included 217 Black and 960 white patients. In addition, the study controlled for 20 other factors, including educational level, cigarette smoking, psychological issues such as pain catastrophizing and pain self-efficacy, health-related quality of life, a variety of medical conditions, prior low back surgery and use of opioids for pain control.

The results showed that Black and white patients generally had similar perceptions of their physicians, although Black patients reported that their physicians had more effective and open communication.

“Our findings suggest that factors other than the patient-physician relationship are associated with the health disparities experienced by Black patients with chronic pain,” Licciardone said. “We intend to look at other systemic factors within health care delivery that may explain these disparities, including access to nonpharmacological treatments for chronic pain and physician adherence to clinical practice guidelines.”

More than 500 million people worldwide suffer from low back pain — the leading cause of disability, according to the Global Burden of Disease Study funded by the Bill & Melinda Gates Foundation.

The full text of the article is freely available at

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