Racial and Ethnic Disparities in Acute Pain Control

We aim to compare pain management among three groups of ethnic disparity (ED) patients, Hispanics, non-Hispanic Blacks, non-Hispanic Whites, and assess whether the observed association between pain management and race/ethnicity is independent of potentially important confounding variables (e.g., age, sex, insurance status, education). We also aim to assess whether the effect of race/ethnicity on adequacy of pain management is explained by patients’ initial pain intensity or by discordance between patient and physician’s: a) race/ethnicity; b) perception of patient’s pain. To do this 285 patients with long-bone fractures will be recruited in the EDs of one municipal and one voluntary hospital serving an inner-city, disadvantaged population in the Bronx. Data will be collected on pain using self-reported pain and non-verbal pain expressions at baseline, one hour post-baseline, and discharge. Data on analgesics administered, patient and physician characteristics will also be collected.

We plan to conduct a chart review of long bone fractures in 2000 and 2001 so that we can analyze the association between race/ethnicity and pain management using the same design as published studies. Comparison of the retrospective and prospective studies will strengthen inferences that can be drawn.

We hypothesize that Black and Hispanic patients will be less likely to receive opioid analgesics than white patients.

• Fracture
• Pain

Inclusion Criteria:

• 18 to 55 years;
• Acute pain starting no more than 24 hours before presenting to the ED;
• Have isolated long-bone fracture documented on x-ray;
• Have a complaint of pain at triage or complaining of pain to the physician;
• English and Spanish speaking

Exclusion Criteria:

• Participating in another clinical study at the time of entry;
• Unable to complete the pain intensity scale, or complete the questionnaire because of inability to understand the task and questions;
• Intoxication with alcohol or other drug;
• Pregnancy;
• Methadone use;
• Use of opioids or tramadol in past seven days;
• Patients who are allergic to any analgesics;
• Patients with a chronic pain syndrome (sickle cell anemia, fibromyalgia, migraine, peripheral neuropathies)