Abstract
Background
Pain management is critical to the management of patients in the emergency department
(ED). The clinical decision-making process for prescribing medications is complicated
by its subjective nature. Historically, racial and ethnic minority groups and women
have not had their pain managed as aggressively as White and male patients.
Objective
The objective of this study was to determine whether race and biological sex affect
the pain management process by means of evaluating data from a large hospital system
with diverse patient demographic characteristics.
Methods
This was a retrospective study of adult patients who presented an ED within the hospital
system and were discharged from the ED with a diagnosis of undifferentiated abdominal
pain during a single year. Patient pain was classified as mild, moderate, or severe,
and patients were further stratified by race, ethnicity, sex, and insurance status.
Pain management was assessed by narcotic vs non-narcotic administration.
Results
A total of 32,676 patients were included in the study. Narcotic administration was
more likely in White patients with undifferentiated abdominal pain (22%) compared
with Black patients (12%; adjusted odds ratio 0.50; 95% CI 0.46–0.54). This persists
across patient-reported pain scores. In addition, women (16.99%) were prescribed narcotics
less often than men (19.41%; p < 0.0001).
Conclusions
Although differences in pain management practices have been explored previously, this
study provided a large, updated, multifacility assessment that confirmed that race-
and sex-based differences in pain management persist, specifically in the decision
to treat with narcotics. Further investigation is warranted to determine the root
causes of these differences.
Keywords
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Article info
Publication history
Published online: September 09, 2022
Accepted:
September 4,
2022
Received in revised form:
August 8,
2022
Received:
January 21,
2022
Footnotes
This research was presented at the American College of Emergency Physicians Annual Meeting October 26, 2020.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
