Differences In Pain Treatment Research Articles

Differences in pain treatment between surgeons and anaesthesiologists in a physician staffed prehospital emergency medical service: a retrospective cohort analysis

BackgroundAlthough pain treatment is an important objective in prehospital emergency medicine the incidence of oligoanalgesia is still high in prehospital patients. Given that prehospital emergency medicine in Germany is open for physicians of any speciality, the prehospital pain treatment may differ depending on the primary medical education. Aim of this study was to explore the difference in pain treatment between surgeons and anaesthesiologists in a physician staffed emergency medical service.MethodsRetrospective single centre cohort analysis in a physician staffed ground based emergency medical service from January 2014 until December 2016. A total of 8882 consecutive emergency missions were screened. Primary outcome measure was the difference in application frequency of prehospital analgesics by anaesthesiologist or surgeon. Univariate and multivariate logistic regression analysis was used for statistical analysis including subgroup analysis for trauma and acute coronary syndrome.ResultsA total of 8238 patients were included in the analysis. There was a significant difference in the application frequency of analgesics between surgeons and anaesthesiologists especially for opioids (p < 0.001, OR 0.68 [0.56–0.82]). Fentanyl was the most common administered analgesic in the trauma subgroup, but significantly less common used by surgeons (p = 0.005, OR 0.63 [0.46–0.87]). In acute coronary syndrome cases there was no significant difference in morphine administration between anaesthesiologists and surgeons (p = 0.49, OR 0.88 [0.61–1.27]).ConclusionsIncreased training for prehospital pain treatment should be implemented, since opioids were administered notably less frequent by surgeons than by anaesthesiologists.

Obstetrical Providers' Management of Chronic Pain in Pregnancy: A Vignette Study.

Describe obstetrical providers' management of a hypothetical case on chronic pain in pregnancy and determine whether practices differ based on patient race. This was a self-administered survey at a clinical conference. Seventy-six obstetrician-gynecologists and one nurse practitioner were surveyed. A case-vignette described a pregnant patient presenting with worsening chronic lower back pain, requesting an opioid refill and increased dosage. We varied patient race (black/white) across two randomly assigned identical vignettes. Providers indicated their likelihood of prescribing opioids, drug testing, and referring on a 0 (definitely would not) to 10 (definitely would) scale; rated their suspicions/concerns about the patient on a 0-10 VAS scale; and ranked those concerns in order of importance. We calculated correlation coefficients, stratifying analyses by patient race. Providers were not inclined to refill the opioid prescription (median = 3.0) or increase the dose (median = 1.0). They were more likely to conduct urine drug tests on white than black patients ( P = 0.008) and more likely to suspect that white patients would divert the medication ( P =0.021). For white patients, providers' highest-ranked concern was the patient's risk of abuse/addiction, whereas, for black patients, it was harm to the fetus. Suspicion about symptom exaggeration was more closely related to decisions about refilling the opioid prescriptions and increasing the dose for black patients (r = -0.357, -0.439, respectively), whereas these decisions were more closely correlated with concerns about overdose for white patients (r = -0.406, -0.494, respectively). Provider suspicion and concerns may differ by patient race, which may relate to differences in pain treatment and testing. Further study is warranted to better understand how chronic pain is managed in pregnancy.

Poster 495 Gender Differences in Pain Treatment at a University-Affiliated Pain Clinic in Richmond, VA

Poster 495 Gender Differences in Pain Treatment at a University-Affiliated Pain Clinic in Richmond, VA

The Influence of Patient Sex, Provider Sex, and Sexist Attitudes on Pain Treatment Decisions

Research suggests that patient sex, provider sex, and providers' sexist attitudes interact to influence pain care; however, few empirical studies have examined these influences. We investigated sex (patient and provider) differences in pain treatment and the extent to which providers' sexist attitudes were associated with these differences. Ninety-eight health care providers (52% female) completed the Ambivalent Sexism Inventory and made treatment ratings for 16 computer-simulated patients with low back pain. Patient sex was balanced across vignettes. Results indicated that female patients received significantly higher antidepressant (F[1, 96] = 4.51, P < .05, ηp2 = .05) and mental health referral (F[1, 96] = 3.89, P = .05, ηp2 = .04) ratings than male patients, which is consistent with our hypotheses; however, these differences were significant only among female providers. Controlling for providers' sexism scores did not substantially alter these results, which is counter to our hypotheses. These results suggest that female providers are more likely to recommend psychosocial treatments for female than for male pain patients, and providers' sexist attitudes do not account for these differences. Research is needed to elucidate the contributors to sex/gender differences in treatment in order to reduce pain disparities. PerspectiveThe results of this study suggest that patient and provider sex, but not providers' sexist attitudes, influence pain care. These findings may inform efforts to raise awareness of sex/gender differences in pain care and reduce disparities.

Racial Differences in Prescription of Opioid Analgesics for Chronic Noncancer Pain in a National Sample of Veterans

The purpose of this study was to investigate possible racial differences in opioid prescriptions among primary care patients with chronic noncancer pain receiving care in the Veterans Affairs health care system. This was a retrospective cohort study of 99,903 veterans with diagnoses of low back, neck, or joint pain selected to participate in the Veterans Affairs Survey of the Healthcare Experiences of Patients in fiscal year 2006. The outcome was prescription of opioids in the year following the first pain diagnosis, obtained through electronic medical record data. Analyses incorporated fixed effects for race, most recent pain intensity rating, new or established primary care patient status, and an interaction between race and most recent pain intensity rating, together with random effects for health care facility and race within facility. The association between patient race and prescription of opioids was moderated by baseline level of pain intensity scores (assessed on a 0–10 scale) and patient age. Among patients under 65 years of age, blacks with moderate (4–6) or high (7–10) levels of pain were less likely to receive opioids than whites (P = .0025, P = .0011); however, there were no significant differences between black and white patients with low levels of pain intensity (1–3) and those with pain intensity ratings of 0 (no pain). Among patients 65 and older with pain intensity ratings of zero, blacks were more likely than whites to receive opioid prescriptions (P = .0087), but there were no significant racial differences in opioid prescriptions in those with low to high levels of pain. PerspectiveAmong veterans under age 65 reporting moderate to high levels of chronic noncancer pain, blacks were less likely to be prescribed opioids than whites, even after controlling for clinical and system-level factors. Results underscore the challenges of eliminating racial differences in pain treatment, despite comprehensive systemwide improvement initiatives.

Peripartum pain management in opioid dependent women

Increased pain sensitivity and the development of opioid tolerance complicate the treatment of pain experiencedby opioid maintained pregnantwomenduring delivery and the perinatal period. Theaim of the present study was to investigate differences in pain management of opioid maintained compared to nondependent pregnant women during delivery and the postpartum period. 40 deliveries of 37 opioid dependent women enrolled in a double-blind, double-dummy randomized controlled trial (RCT) examining the safety and efficacy of methadone (mean dose at the time of delivery = 63.89 mg) and buprenorphine (mean dose at the time of delivery = 14.05 mg) during pregnancy were analyzed and participants were matched to a non-dependent comparison group of 80 pregnant women. Differences in pain management (opioid and non-opioid analgesic medication) during delivery and perinatal period were analyzed. Following cesarean delivery opioid maintained women received significantly less opioid analgesics (day of delivery p = 0.038; day 1: p = 0.02), NSAIDs were administered more frequently to opioid dependent patients than to the comparison group during cesarean section and on the third day postpartum. Significantly higher nicotine consumption in the group of opioid dependentwomenhad a strong influence onthe retrieved results, and might be considered as an independent factor of altered pain experience. Differences in pain treatment became evident when comparing opioid maintained women to healthy controls. These differences might be based on psychosocial consequences of opioid addiction along with the lack of an interdisciplinary consensus on pain treatment protocols for opioid dependent patients.

Racial Differences in Pain Treatment and Empathy in a Canadian Sample

Evidence of inadequate pain treatment as a result of patient race has been extensively documented, yet remains poorly understood. Previous research has indicated that nonwhite patients are significantly more likely to be undertreated for pain. To determine whether previous findings of racial biases in pain treatment recommendations and empathy are generalizable to a sample of Canadian observers and, if so, to determine whether empathy biases mediate the pain treatment disparity. Fifty Canadian undergraduate students (24 men and 26 women) watched videos of black and white patients exhibiting facial expressions of pain. Participants provided pain treatment decisions and reported their feelings of empathy for each patient. Participants demonstrated both a prowhite treatment bias and a prowhite empathy bias, reporting more empathy for white patients than black patients and prescribing more pain treatment for white patients than black patients. Empathy was found to mediate the effect of race on pain treatment. The results of the present study closely replicate those from a previous study of American observers, providing evidence that a prowhite bias is not a peculiar feature of the American population. These results also add support to the claim that empathy plays a crucial role in racial pain treatment disparity.

Ethnic Wait Time Differences in Analgesic Administration in the Emergency Department

Although many studies have documented ethnic disparities in analgesia administration, few have dealt with the wait time for analgesia in the emergency department, despite the fact that the provision of timely and appropriate analgesia should be a primary goal in caring for patients. Inadequate analgesia has been reported for patients presenting with long bone fractures, and a body of evidence exists indicating that ethnic and minority patients may be receiving inadequate pain care when presenting to the emergency department for treatment of long bone fractures. The purpose of the present research was to determine whether wait time differences in pain treatment existed for ethnic and minority adults (18 years old or older) who were admitted to the emergency department suffering from long bone fractures using a quantitative retrospective design. Purposive sampling of medical records of 234 European-American, African-American, and Hispanic patients presenting with long bone fractures from two small Georgia hospitals were analyzed. Although Hispanic, European-American, and African-American patients in this study all reported substantial pain, a significant ( p = .005) overall wait time difference was found between Hispanic and European-American patients, with Hispanic patients waiting an average of 102 minutes for the first dose of analgesia, and the European-Americans waiting an average of 67 minutes. Significant ( p = .011) wait time differences were also found between Hispanics and European Americans when opioids were ordered and when there was a nurse notation of pain in the record ( p = .029).

Racial Differences in Pain Treatment

Racial Differences in Pain Treatment

Searching for relief: racial differences in treatment of patients with back pain

The purpose of the study was to investigate the impact of race/ethnicity on analgesic prescriptions for back pain. Using 1995–1998 data from the U.S. National Hospital Ambulatory Medical Care Survey, significant racial disparities were observed in the odds of prescriptions. African American (OR=0.67, CI=0.55, 0.83) and Hispanic patients (OR=0.70, CI=0.52, 0.93) were significantly less likely to be given prescriptions for back pain treatment than their White counterparts. These two groups also received fewer medications on average than Whites. When the sample was stratified by sex, the racial differences were even more startling. African American men (OR=0.49, CI=0.35, 0.68) and Hispanic men (OR=0.51, CI=0.33, 0.79) were considerably less likely than White men to be given prescriptions for back pain. In addition, African American male patients were less likely to receive any medications (prescribed or non-prescribed) for pain. The above findings remained even after controlling for pain severity and payment source. The authors concluded that prejudice and racial stereotyping among physicians are the most plausible explanations for the racial/ethnic differences in pain treatment.

Searching for relief: racial differences in treatment of patients with back pain

The purpose of the study was to investigate the impact of race/ethnicity on analgesic prescriptions for back pain. Using 1995–1998 data from the U.S. National Hospital Ambulatory Medical Care Survey, significant racial disparities were observed in the odds of prescriptions. African American (OR=0.67, CI=0.55, 0.83) and Hispanic patients (OR=0.70, CI=0.52, 0.93) were significantly less likely to be given prescriptions for back pain treatment than their White counterparts. These two groups also received fewer medications on average than Whites. When the sample was stratified by sex, the racial differences were even more startling. African American men (OR=0.49, CI=0.35, 0.68) and Hispanic men (OR=0.51, CI=0.33, 0.79) were considerably less likely than White men to be given prescriptions for back pain. In addition, African American male patients were less likely to receive any medications (prescribed or non-prescribed) for pain. The above findings remained even after controlling for pain severity and payment source. The authors concluded that prejudice and racial stereotyping among physicians are the most plausible explanations for the racial/ethnic differences in pain treatment.

Race, ethnicity, and pain treatment: striving to understand the causes and solutions to the disparities in pain treatment.

would like for them to know that I am in pain or this part of my body hurts or the other part hurts — that I am not lying about it. To examine me and to cut down on the pain….And help me out.Patient with Sickle Cell Disease, Focus Group ParticipantPain in the United States is widely recognized to be undertreated; however, the capacity to treat pain has never been greater. The causes of this undertreatment are varied. As we focus on pain and why it is too often ineffectively treated, we also discover that this undertreatment afflicts some more than others. What divides the some from the others isn't limited to one factor, but one particularly disturbing factor is race and ethnicity. Racial and ethnic minority populations are at higher risk for oligoanalgesia, or the ineffective treatment of pain. Only through further study of the differences in pain treatment based on race and ethnicity can we develop strategies to reduce the disparities in care.