NEW YORK, Dec 28 (Reuters Health) -- Black patients with a broken arm or
leg are less likely to be given pain medication in the emergency room than
whites with similar injuries and complaints of pain, according to a report.
The finding should be a "wake-up call for emergency physicians," according
to Drs. Lewis Goldfrank and Robert Knopp, who wrote an editorial accompanying
the report in the January issue of Annals of Emergency Medicine.
The study adds to accumulating "evidence that minority patients are not
receiving timely and appropriate medical care when compared with nonminority
groups," they write.
In the study, Dr. Knox Todd and colleagues at Emory University in Atlanta,
Georgia, looked at the medical records of 201 patients who had been treated for
a broken arm or leg at a single emergency department in the city. They found
that 74% of white patients received pain medication compared with only 57% of
black patients.
The difference was greater than could have occurred by chance, the
researchers determined. They calculated that the risk of receiving no pain
medication was 66% higher for blacks compared with whites, even though the two
groups had similar injuries and similar complaints of pain.
"Inadequate prescribing of pain medication is common among emergency
department patients," Todd says in a statement released by the American College
of Emergency Physicians. "This is the second study we have conducted showing
that minorities are at higher risk than whites for undertreatment of pain."
In the earlier study, the researchers showed that Hispanic patients in Los
Angeles receive pain medication less often than white patients.
Todd and his colleagues believe that the racial bias in analgesic use is
probably not due to differences in the assessment of pain by doctors, or in the
reporting of pain by patients. Rather, it appears that doctors are simply less
likely to prescribe pain medication for black or Hispanic patients than for
white patients.
One reason for the racial differences in pain management may be that "some
patients express pain in a way that is more convincing that they need
medication," Dr. Marcus Martin speculates in an accompanying editorial.
Alternatively, he says, doctors may view some patients as more likely to
become addicted to pain medications, or doctors may treat patients differently
based on how the injury was sustained -- for example, in a ski accident versus
in an encounter with police.
