Written by Gay Moore M.Ed. RNC

The Journal of the Medical Association recently reported on a study concerning the wide disparity between the amounts and types of pain medications given to different races in hospital emergency rooms.

A federally sponsored study of 500 hospital emergency rooms across the United States examined the admission records of 156,729 ER patients involving injuries or illnesses serious enough to warrant pain medicines.

Beginning in the late 1990’s, doctors and nurses were required ask patients about their pain and to rate their level of pain. These procedures were instituted after research revealed that pain was being under-treated, and that not only were people suffering needlessly, but that good pain management led to faster healing. At that time, researchers also discovered that whites were receiving a higher percentage of aggressive pain management as compared to racial minorities.

While over-all levels of pain management have increased, dramatic racial differences continue. White patients are more likely to receive a narcotic pain medication (31%) versus Asians (28%) Hispanics (24%) and Blacks (23%). This disparity persists even for broken bones and kidney stones. Indeed, racial minorities as a whole are more likely to receive non-narcotic medicines like aspirin and ibuprofen.

Amazingly the disparities in pain treatment were found to be more pronounced in the 2005 than in the late 1990’s study. The question remains: why?

Although the researchers found no significant level of outright racism, obviously social factors and subtle racial bias are operating among largely white hospital ER medical personnel.

Possible explanations may include the perception that minorities are more likely to exaggerate symptoms in order to receive more narcotics. These attitudes persist, despite statistics that reveal that whites are more likely to abuse narcotics and engage in “drug seeking” behaviors than minorities.

Other explanations include language barriers. After attempting to communicate, patients may give up and suffer in silence. Cultural basis against asking for pain medicines, especially among males, also needs to be taken into account. Asians, often viewed as the “model minority,” may be viewed as preferring to remain stoic rather than to be given pain medication.

Another, more subtle, explanation is the tendency to see one’s own racial group in a positive light. Taken with beliefs and stereotypes about racial and minority groups, this unconscious tendency may lead to discounting the pain reports of others while viewing members of ones’ own group with more empathy.

Whatever the explanation, it is time to acknowledge the problem and talk about it among those who have direct patient contact, not just administrative and supervisory personnel. Perhaps then unnecessary suffering will be eased and appropriate pain management will be available for all patients.