Ensuring color-blind care in pain management

Just recently posted online is an article presenting an analysis of predictors of clinically important reduction in pain intensity among ER patients.  The investigators found that nonwhite physicians achieved better pain relief with less analgesia.

Here is the abstract:

Physician Race/Ethnicity Predicts Successful Emergency Department Analgesia

This study investigated the association between effectiveness of ED pain treatment and race of patients, race of providers, and the concordance of patient and provider race, with a prospective, multicenter study of patients presenting to 1 of 20 US and Canadian EDs with moderate to severe pain. Primary outcome is a 2-point or greater reduction in pain intensity, measured with an 11-point verbal scale, considered the minimum clinically important reduction in pain intensity. A total of 776 patients were enrolled. The sample included 57% female, 44% white, 26% black, and 26% Hispanic. The physician was white in 85% of encounters. Arrival pain score (adjusted odds ratio, 1.14; 95% CI 1.06, 1.24), receipt of any ED analgesia (1.59; 95% CI 1.17, 2.17), and physician nonwhite race (1.68; 95% CI 1.10, 2.55) were significant predictors of clinically significant reduction in pain intensity in multivariate analysis. Nonwhite physicians achieved better pain control without using more analgesics. Future research should explore the determinants of this difference in patient response to pain treatment related to provider race including provider characteristics and training that were not measured in this study. This study provided no evidence supporting an effect of racial concordance on the primary outcome.

The lead author, Dr. Alan Heins, has previously written that ER pain care is "often inadequate and prone to racial disparities."  For example, although analgesic use in ERs has increased over the years, he says, white patients are still more likely to receive opioid prescriptions.  To further complicate matters, physicians may not realize that various cultures react to pain differently.  For example, Dr. Heins says, Hispanics are often very vocal about their pain, while Native Americans tend to bear pain stoically.

All this suggests more than just brand innovation in pain medications – moving to total treatment innovation.

The study authors are:

Alan Heins
Department of Emergency Medicine
University of South Alabama
Mobile, AL

Peter Homel
Pain and Palliative Care
Beth Israel Medical Center
New York, NY

Basmah Safdar
Section of Emergency Medicine
Department of Surgery
Yale University
New Haven, CT

Knox Todd
Pain and Emergency Medicine Institute
Beth Israel Medical Center
New York, NY