Nonwhite Patients Get Less Pain Relief in US Emergency Rooms

By Lisa Rapaport

(Reuters Health) - Black and Hispanic patients in U.S. emergency rooms are less likely to receive medication to ease acute pain than their white counterparts, a study suggests.

Researchers examined data from 14 previously published studies of pain management in American emergency rooms (ERs) that altogether included 7,070 white patients, 1,538 Hispanic patients, and 3,125 black patients.

Compared to white patients, black patients were 40% less likely to receive medication to ease acute pain and Hispanic patients were 25% less likely, the analysis found.

"The reasons for these disparities are likely complex and multifold and may include factors such as implicit bias, language barriers, and cultural differences in the perception and expression of pain and institutional differences in ERs that serve mostly Black and Hispanic patients," said Dr. Andrew Meltzer, senior author of the study and a researcher at George Washington University School of Medicine & Health Sciences in Washington, D.C.

"Unrelieved pain can lead to a wide range of consequences such as growing distrust towards physicians and the medical community, economic burden from its debilitative effects, and physical and emotional repercussions," Meltzer said by email. "Given the current opioid epidemic, however, it remains unclear if more pain medicine should be a marker of higher quality care."

Black patients were 34% less likely to receive opioids for acute pain than white patients, and Hispanic patients were 13% less likely to get opioids for acute pain, researchers reported June 5 online in the American Journal of Emergency Medicine.

And when patients had long bone fractures or acute pain from other types of traumatic injuries, black people were 41% less likely to get pain medication than white people.

Among patients without fractures or trauma-related pain, black patients were again less likely than white patients to get pain relievers, but in this instance the difference was too small to rule out the possibility that it was due to chance.

Because it wasn't a controlled experiment, the study doesn't prove that race or ethnicity directly impacts how ER clinicians treat acute pain.

One limitation of the analysis is that researchers lacked data on how much pain patients experienced, and it's possible some differences might be due to differences in how much pain patients reported. And researchers also didn't have data to see how health outcomes varied based on the amount or type of pain relief patients received.

"Delayed pain relief may lead to poor healing or prolong the healing," said Dr. Carmen Green, a professor of anesthesiology at the University of Michigan schools of medicine and public health in Ann Arbor.

"In addition, there are psychological, implications ranging from suffering to fear all the way to PTSD," Green, who wasn't involved in the study, said by email. "Let us not forget pain has been used to torture."

Emergency room clinicians may be choosing which patients get pain relief based on conscious, unconscious, and implicit bias as well as negative stereotypes based upon race, ethnicity, and class, Green said.

"We tend to be more sympathetic to those who look like us," Green said. "Overall, racial and ethnic minorities tend to receive lesser quality of care, have lesser quality health insurance, have decreased access to care, and experience diminished outcomes that lead to disparities."

SOURCE: https://bit.ly/2Lyqk3Q

Am J Emerg Med 2019.

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