VANCOUVER, B.C. -- Women, minorities, and the elderly do not get treated for pain as well or as often as white males do, speakers said at a special session of the annual meeting of the American Pain Society.
Inadequate treatment of pain can cause delayed recovery and poor outcomes, they noted.
"One of the critical issues in medicine today is trust--trust between our patients and our practitioners--and the problem of pain and disparities [in treatment] gets to the core of some of those issues," said Dr. Knox H. Todd, director of the Pain and Emergency Medicine Initiative, Atlanta. "It is difficult for the public to trust the medical profession when they see such variations in care."
The federal government has identified the elimination of health care disparities as one of two broad goals of its Healthy People 2010 initiative, and this decade has been labeled the "Decade of Pain" in a campaign to promote better pain management for all groups, Dr. Todd noted.
The roots of these disparities may include differences in culture and income, as well as variation in styles of communication across gender and generations. But much of the evidence points to physician bias, the speakers said.
"We really need to more fully evaluate physician variability regarding pain," said Dr. Carmen Green, director of pain research, University of Michigan, Ann Arbor.
The literature documenting disparity in pain care on the basis of race and ethnicity is only about 10 years old, Dr. Todd pointed out. One of the first studies conducted looked at differences in analgesia use in the emergency department.
Dr. Todd conducted the study at the University of California, Los Angeles, Medical Center, after noticing that when he passed the trauma room and heard cries, the cries were usually in Spanish, even though the medical center is located in an affluent, non-Hispanic neighborhood, he said.
So he compared analgesic use in white patients and Hispanic patients treated for an isolated, long-bone, extremity fracture over a 2-year period. He reported that 75% of 108 white patients with a long-bone fracture received analgesia, compared with 45% of 31 Hispanic patients (JAMA 269:1537-39, 1993).
In a follow-up, prospective study of long-bone fractures, Dr. Todd showed that Hispanics and whites do not rate the degree of their pain any differently, and that physicians, when prompted, were able to judge the amount of pain a patient was in equally well for both groups (JAMA 271:925-28, 1994). …