No gender-related bias in acute musculoskeletal pain management in the emergency department

Uri, Ofir; Elias, Shlomo; Behrbalk, Eyal; Halpern, Pinchas

doi:10.1136/emermed-2013-202716

Cited by 19 publications

(26 citation statements)

References 21 publications

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“…Patient SES did not have a significant effect on nurses' intentions of offering emotional or instrumental support nor on the Manchester Triage. This pattern of findings is in line with previous studies on social disparities in pain care, where biases could indeed be found on pain assessments but not on pain management practices (3,39). This pattern may eventually be understood as a result of a disconnection between implicit biases and actual behaviour.…”

Section: Discussionsupporting

confidence: 90%

Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses’ Pain Assessment and Management Practices

et al. 2019

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Objective Research on social disparities in pain care has been mainly focused on the role of race/racism and sex/sexism. Classism in pain assessment and management practices has been much less investigated. We aimed to test the effect of patient socioeconomic status (SES; a proxy of social class) on nurses’ pain assessment and management practices and whether patient SES modulated the effects of patient distress and evidence of pathology on such practices. Design Two experimental studies with a two (patient SES: low/high) by two (patient distress or evidence of pathology: absent/present) between-subject design. Subjects Female nurses participated in two experimental studies (N = 150/N = 158). Methods Nurses were presented with a vignette/picture depicting the clinical case of a female with chronic low back pain, followed by a video of the patient performing a pain-inducing movement. Afterwards, nurses reported their pain assessment and management practices. Results The low-SES patient’s pain was assessed as less intense, more attributed to psychological factors, and considered less credible (in the presence of distress cues) than the higher-SES patient’s pain. Higher SES buffered the detrimental impact of the presence of distress cues on pain assessment. No effects were found on management practices. Conclusions Our findings point to the potential buffering role of SES against the detrimental effect of certain clinical cues on pain assessments. This study contributes to highlighting the need for further investigation of the role of SES/social class on pain care and its underlying meanings and processes.

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Section: Discussionsupporting

confidence: 90%

Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses’ Pain Assessment and Management Practices

et al. 2019

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“…16 The commission noted a paucity of studies on gender differences in the assessment and treatment of acute pain in the ED. 16 Previous studies have yielded conflicting evidence about the existence of gender based differences in pain care, 5, 8, 17–19 but these studies have been limited to a single type of pain (e.g. abdominal or back pain), a single study site, or were vulnerable to confounders such as ED crowding.…”

Section: Introductionmentioning

confidence: 99%

A Multicenter Evaluation of the Impact of Sex on Abdominal and Fracture Pain Care

et al. 2015

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Background Previous studies examining gender-based disparities in Emergency Department (ED) pain-care have been limited to a single pain-condition, a single study-site, and lack rigorous control for confounders. Objective A multicenter evaluation of the effect of gender on abdominal pain (AP) and fracture (FP) pain-care outcomes. Research Design Retrospective cohort-review of ED visits at 5 US hospitals in January, April, July and October 2009. Subjects 6,931 patients with a final ED diagnosis of FP (n=1682) or AP (n=5249). Measures The primary-predictor was gender. The primary outcome was time to analgesic-administration. Secondary outcomes included time to medication-order, and the likelihood the receiving an analgesic and change in pain scores 360 minutes after triage: Multivariable models, clustered by study site, were conducted to adjust for race, age, comorbidities, initial pain-score, ED crowding and triage acuity. Results On adjusted analyses, compared with men, women with AP waited longer for analgesic administration [AP Women: 112 (65–187) min, Men: 96 (52–167) min, p<0.001] and ordering Women: [84 (41–160) min, Men: 71 (32–137) min, p<0.001], whereas women with FP did not (Administration: p=0.360; Order: p=0.133). Compared with men, women with AP were less likely to receive analgesics in the first 90 minutes (OR: 0.766, 95% CI: 0.670 – 0.875, p<0.001), whereas women with FP were not (p=0.357). Discussion In this multicenter study, we found that women experienced delays in analgesic administration for AP, but not for FP. Future research and interventions to decrease gender-disparities in pain-care should take type of pain into account.

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“…We acknowledge some limitations. The small sample size limits the generalizability of the study findings albeit with similarities to the musculoskeletal pain populations previously described regarding middle-age adults (39), female predominance (39), overweight (40), sedentary lifestyle (41), moderate level of the pain intensity (42,43), and pain duration (43). All patients had musculoskeletal pain without considering the individual characteristics of each disease belonging to this population.…”

Section: Fig 3 Comparison Of the Difference Between The Final And Imentioning

confidence: 86%

Patients with Impaired Descending Nociceptive Inhibitory System Present Altered Cardiac Vagal Control at Rest

Nogueira

2018

Pain Phys

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Background: Patients with chronic musculoskeletal pain have a higher chance of presenting impairment in cardiovascular autonomic modulation, which may have implications for cardiovascular events. The autonomic nervous system plays an important role in pain modulation. However, it is unclear whether patients with inefficient descending nociceptive inhibition have poorer cardiovascular autonomic modulation. Objective: To compare the cardiovascular autonomic modulation of patients with musculoskeletal pain who had normal versus impaired functioning of descending nociceptive inhibitory system (DNIS). Study Design: A cross-sectional study. Setting: Physiotherapy outpatient service. Methods: Fifty-six patients with musculoskeletal pain were included. Conditioned pain modulation was assessed by the difference of algometric values held in the dorsal forearm and tibialis anterior muscle, before and after a thermal pain stimulus was employed via the cold pressure test (CPT). Patients with inefficient DNIS in both sites were classified as impaired responders (n = 14). The others were classified as normal responders (n = 42). Cardiac autonomic modulation was monitored at rest by heart rate variability (HRV). The blood pressure response to the CPT was used as a proxy of sympathetic responsiveness. Results: Most of the patients were women (60%) and had chronic pain (75%). The groups had similar demographic characteristics. Patients with impaired DNIS showed lower HRV [RMSSD (P = 0.020), SDRR (P = 0.009), HF (ms2 ) (P = 0.027), LF (ms2 ) (P = 0.004), and total power (P = 0.002)]. The blood pressure response to CPT was similar between groups (systolic pressure, P = 0.813; diastolic pressure, P = 0.709). Limitation: Physical activity level, emotional changes, and visceral pathologies can alter the autonomic nervous system and may represent potential confounders. The low number of patients may have biased the results. Conclusion: Patients with impaired DNIS presented lower resting HRV, indicating an altered vagal control of the heart. In contrast, the blood pressure response to a sympathoexcitatory stimulus was preserved. The study was approved by the Research Ethics Committee of Augusto Motta University Centre (CAAE number: 46245215.9.0000.5235), and all patients signed the Informed Consent Form. Key words: Musculoskeletal pain, autonomic nervous system, heart rate, chronic pain, diffuse noxious inhibitory control, blood pressure, sympathetic nervous system, parasympathetic nervous system

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No gender-related bias in acute musculoskeletal pain management in the emergency department

Abstract: Our findings suggest that a standardised pain management protocol based on patients' subjective pain rating may reduce gender-related bias in acute musculoskeletal pain management.

Cited by 19 publications

References 21 publications

Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses’ Pain Assessment and Management Practices

Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses’ Pain Assessment and Management Practices

A Multicenter Evaluation of the Impact of Sex on Abdominal and Fracture Pain Care

Patients with Impaired Descending Nociceptive Inhibitory System Present Altered Cardiac Vagal Control at Rest

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