Pain Management Nursing
Volume 9, Issue 2 , Page 45, June 2008

Are There Racial and Ethnic Differences in the Administration of Analgesia?

College of Nursing, Villanova University, Villanova, Pennsylvania

Article Outline

 

Were you surprised by the outcomes of the research reported in the March issue of Pain Management Nursing? Epps, Ware and Packard (2008) report an excellent and balanced review of the literature and note that Hispanics were twice as likely as similar non-Hispanics to receive no pain medication when treated in the emergency department. In a study reported by Todd and colleagues (2000) it was noted that white patients were significantly more likely to receive analgesics compared to black patients who reported similar complaints of pain.

Using hypothetical vignettes Weisse and colleagues (2001) noted that race affected the decisions made by primary care physicians. Race and gender was varied among the otherwise similar vignettes. It was noted that male physicians prescribed more analgesia to whites with renal colic and female physicians prescribed more analgesics to blacks.

Pletcher, Kertesz, Kohn and Gonzales (2008) conducted a national survey using data on emergency department visits collected by the National Hospital Ambulatory Medical Care Survey. The data used was from 1993 to 2005. The investigators wanted to determine whether non-Hispanic white patients were more likely to receive an opioid compared to other racial/ethnic groups. The first reason for visit code was pain related in 36 million emergency department visits (81%). Whites made 66% of all pain-related visits while blacks made 20%, Hispanics 11% and Asians/others 2%. Opioid prescribing was more likely for pain related visits made by whites (31%) than for blacks (23%), Hispanics (24%) or Asian/others (28%). Blacks were prescribed opioids at lower rates than any other race/ethnicity group. Nonopioid analgesia alone was prescribed more frequently for nonwhites (32%) than whites (26%).The authors recommend increased education and the promotion of cultural competence.

Epps and colleagues took a slightly different spin in that they measured the waiting time (WT) between admission to the emergency department (ED) and the first dose of analgesia. There was a significant difference between Hispanic and European-American patients in WT with Hispanics waiting 102 minutes for the first dose of analgesia. The European Americans received analgesia in an average of 67 minutes.

I circulated the Epps et al. article among my colleagues and no one was surprised by the results. Here we are still in the decade of pain research and much effort by many different organizations has tried to bring pain issues to the forefront in order to improve pain management. Have these efforts improved pain management for only a few? More research needs to be done regarding the barriers of culture and language. How can we change our practice to overcome these barriers?

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References 

  1. Epps CD, Ware LJ, Packard A. Ethnic wait time differences in analgesic administration in the emergency department. Pain Management Nursing. 2008;9(1):26–32
  2. Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. Journal of the American Medical Association. 2008;299(1):70–78
  3. Todd KH, Deaton D, D'Adamo AP, Goe I. Ethnicity and analgesic practice. Annals of Emergency Medicine. 2000;35:11–16
  4. Weisse C, Sorum P, Sanders K, Syat B. Do gender and race affect decisions about pain management?. Journal of General Internal Medicine. 2001;16(4):211–217

PII: S1524-9042(08)00087-8

doi:10.1016/j.pmn.2008.04.001

Pain Management Nursing
Volume 9, Issue 2 , Page 45, June 2008

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