Minorities less likely to get pain relief-US study

Tue Jan 1, 2008 4:00pm EST

CHICAGO Jan 1 (Reuters) - Black and Hispanic patients in pain are less likely than whites to get powerful painkillers from U.S. hospital emergency departments, but the reasons may go beyond sheer racial bias, researchers said on Tuesday.

In a look at 375,000 emergency room visits over 13 years, a study found 31 percent of whites in pain received opioid drugs -- a broad class of narcotic painkillers dispensed only by prescription -- compared to 23 percent of blacks and 24 percent of Hispanics.

In contrast, 36 percent of minority patients received less-potent, non-opioid pain relievers such as acetaminophen and ibuprofen during emergency room visits, compared to 26 percent of white patients.

There may several reasons behind the racial disparity, Dr. Mark Pletcher, the study's author, wrote in this week's issue of the Journal of the American Medical Association.

Pain relief received more attention in the late 1990s, and formal U.S. guidelines issued in 2001 called for improved monitoring and control of patient pain. Overall, use of opioids in hospital emergency departments increased from 23 percent of patients in 1993 to 37 percent in 2005, the researchers said.

"Studies in the 1990s showed a disturbing racial or ethnic disparity in the use of these potent pain relievers, but we had hoped that the recent national efforts at improving pain management in emergency departments would shrink this disparity," Pletcher, of the University of California at San Francisco, said in a statement.

"Unfortunately, this is not the case," he said.

While health care providers would be loathe to admit it, they may show racial bias in assessing whether a patient is exaggerating symptoms to obtain powerful painkillers to either sell or abuse, the report said.

But the study found the largest racial disparity in providing stronger medications was found among patients in the most pain and those aged 12 or younger who are unlikely to be drug abusers.

"There is no evidence that nonwhites have less severe or different types of pain when they arrive in the emergency department," Pletcher said. "We think our data indicate that opioids are being underprescribed to minority emergency department patients, especially black and Hispanic patients."

A factor may be that white patients are more likely to expect and demand relief from pain and better convey their symptoms in comparison to minority patients, the report said.

Whites -- who are more likely to have health insurance -- may also be overprescribed the drugs, it said.

But the persistent racial disparity suggested changes are needed in emergency room protocols for pain management, it concluded. (Reporting by Andrew Stern; editing by Vicki Allen)