Racial disparities in pain children of children with appendicitis in EDs

September 14, 2015

Black children were less likely to receive any pain medication for moderate pain and less likely to receive opioids for severe pain than white children in a study of racial disparities in the pain management of children with appendicitis in emergency departments, according to an article published online by JAMA Pediatrics.

Racial and ethnic differences in the emergency department (ED) management of pain have been described, with lower rates of opioid prescription for black and Hispanic patients than for white patients. However, there are fewer studies in children. Appendicitis is the most common surgical cause of abdominal pain in the ED and the use of analgesia to patients with appendicitis is encouraged.

Monika K. Goyal, M.D., M.S.C.E., of the Children's National Health System, Washington, and coauthors suggest that examining pain management among children diagnosed with appendicitis provides a more appropriate example in which to evaluate racial differences in the administration of analgesia.

The authors used data from the National Hospital Ambulatory Medical Care Survey from 2003 to 2010 to analyze both the administration of opioid and nonopioid analgesia.

Of an estimated almost 1 million children evaluated in EDs who were diagnosed with appendicitis, 56.8 percent of patients received any analgesia and 41.3 percent received any opioid analgesia, according to the results.

When analyzed by pain score and adjusted for ethnicity, black patients with moderate pain were less likely to receive any analgesia than white patients. Among those patients with severe pain, black patients were less likely to receive opioids than white patients.

While there was no significant difference in overall analgesia administration by race when multiple variables were accounted for, there was a difference in opioid administration by race: black children with appendicitis were less likely to receive opioid analgesia than white children (12.2 percent vs. 33.9 percent.)

Study limitations noted by the authors include patients possibly declining analgesia despite pain and the authors not being able to account for any analgesia patients may have received prior to arriving at the ED.

"Our findings suggest that there are racial disparities in opioid administration to children with appendicitis, even after adjustment for potential confounders. More research is needed to understand why such disparities exist. This could help inform the design of interventions to address and eliminate these disparities and to improve pain management for all youths," the study concludes.

(JAMA Pediatr. Published online September 14, 2015. doi:10.1001/jamapediatrics.2015.1915. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: This study was supported by a grant from the National Institutes of Health. Please see article for additional information, including other authors, author contributions and affiliations, etc.

Editorial: Pain and Prejudice

In a related editorial, Eric W. Fleegler, M.D., M.P.H., and Neil L. Schechter, M.D., of Boston Children's Hospital and Harvard Medical School, Boston, write: "How do we explain the persistence of these disparities in treatment? ... 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. ... 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."

(JAMA Pediatr. Published online September 14, 2015. doi:10.1001/jamapediatrics.2015.2284. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see article for additional information, including other authors, author contributions and affiliations, etc.
-end-
Media Advisory: To contact corresponding author Monika K. Goyal, M.D., M.S.C.E., call Emily Hartman at 301-244-6728 or email ehartman@childrensnational.org. To contact corresponding editorial author Neil L. Schechter, M.D., call Erin C. Tornatore at 617-919-3113 or email Erin.Tornatore@childrens.harvard.edu
-end-


The JAMA Network Journals

Related Pain Articles from Brightsurf:

Pain researchers get a common language to describe pain
Pain researchers around the world have agreed to classify pain in the mouth, jaw and face according to the same system.

It's not just a pain in the head -- facial pain can be a symptom of headaches too
A new study finds that up to 10% of people with headaches also have facial pain.

New opioid speeds up recovery without increasing pain sensitivity or risk of chronic pain
A new type of non-addictive opioid developed by researchers at Tulane University and the Southeast Louisiana Veterans Health Care System accelerates recovery time from pain compared to morphine without increasing pain sensitivity, according to a new study published in the Journal of Neuroinflammation.

The insular cortex processes pain and drives learning from pain
Neuroscientists at EPFL have discovered an area of the brain, the insular cortex, that processes painful experiences and thereby drives learning from aversive events.

Pain, pain go away: new tools improve students' experience of school-based vaccines
Researchers at the University of Toronto and The Hospital for Sick Children (SickKids) have teamed up with educators, public health practitioners and grade seven students in Ontario to develop and implement a new approach to delivering school-based vaccines that improves student experience.

Pain sensitization increases risk of persistent knee pain
Becoming more sensitive to pain, or pain sensitization, is an important risk factor for developing persistent knee pain in osteoarthritis (OA), according to a new study by researchers from the Université de Montréal (UdeM) School of Rehabilitation and Hôpital Maisonneuve Rosemont Research Centre (CRHMR) in collaboration with researchers at Boston University School of Medicine (BUSM).

Becoming more sensitive to pain increases the risk of knee pain not going away
A new study by researchers in Montreal and Boston looks at the role that pain plays in osteoarthritis, a disease that affects over 300 million adults worldwide.

Pain disruption therapy treats source of chronic back pain
People with treatment-resistant back pain may get significant and lasting relief with dorsal root ganglion (DRG) stimulation therapy, an innovative treatment that short-circuits pain, suggests a study presented at the ANESTHESIOLOGY® 2018 annual meeting.

Sugar pills relieve pain for chronic pain patients
Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology.

Peripheral nerve block provides some with long-lasting pain relief for severe facial pain
A new study has shown that use of peripheral nerve blocks in the treatment of Trigeminal Neuralgia (TGN) may produce long-term pain relief.

Read More: Pain News and Pain Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.