Wow: Black Children Less Likely to Be Given Pain Medication in ER
Black children are less likely than white children to get painkillers when they arrive in the emergency room, according to new research.
“Black patients with moderate pain were less likely to receive any analgesia, and black patients with severe pain were less likely to be treated with opioids,” Monika Goyal, M.D., of the Children’s National Health System in Washington, and colleagues wrote in the Journal of the American Medical Association’s JAMA Pediatrics.
Why? Experts point to a combination of reasons: an unwarranted fear of opioids such as morphine and fentanyl and an unconscious bias against African-American children.
For the study, researchers analyzed national survey data from 2003 to 2010, covering more than 900,000 children with acute appendicitis. The findings show only 57 percent of the kids received any kind of pain reliever in the emergency department for acute appendicitis, and only 41 percent got an opioid drug. Just 12 percent of black children got an opioid drug for pain. Opioids are strongly recommended for appendicitis.
“Our findings suggest that there are racial disparities in opioid administration to children with appendicitis,” Dr. Goyal said. “Although clinicians may recognize pain equally across racial groups, they may be reacting to the pain differently by treating black patients with nonopioid analgesia, such as ibuprofen and acetaminophen, while treating white patients with opioid analgesia for similar pain.”
In the past, experts say, there were fears that giving painkillers would mask symptoms important for diagnosing the causes of abdominal pain. There’s also a reluctance to treat children with opioids; concerns range from possible overdose to developing a dependence on the drugs. Protocols are in place to make sure these fears and concerns are unnecessary.
Physicians not involved with the study find the results disturbing, saying emergency department doctors aren’t doing their jobs if they don’t control pain in all children, including black children.
“If there is no physiological explanation for differing treatment of the same phenomena, we are left with the notion that subtle biases, implicit and explicit, conscious and unconscious, influence the clinician’s judgment,” Eric Fleegler, M.D., and Neil Schechter, M.D., of Boston Children’s Hospital and Harvard Medical School, wrote in an accompanying commentary. “It is clear that despite broad recognition that controlling pain is a cornerstone of compassionate care, significant disparities remain in our approach to pain management among different populations. Strategies and available knowledge exist to remedy this unfortunate situation; we can and should do better.”
Previous studies have shown similar biases in treatment with pain medication and in medical treatment overall, so the experts weren’t surprised by this study’s results. “These findings fit a longstanding pattern,” Drs. Fleegler and Schechter wrote. “There is a substantial body of evidence documenting health-care disparities during the past three decades, including disparities in pain management.”
Have you experienced this in an emergency room with your child? Is this caring or just racist?