The effect of ethnicity on prescriptions for patient-controlled analgesia for post-operative pain

Abstract

We studied if ethnicity influences patient-controlled analgesia (PCA) for the treatment of post-operative pain. Using a retrospective record review, we examined data from all patients treated with PCA for post-operative pain from January to June 1993. We excluded patients who did not have surgery prior to the prescription of PCA or were not prescribed PCA in the immediate post-operative period. The sample consisted of 454 subjects. While there were no differences in the amount of narcotic self-administered, there were significant differences in the amount of narcotic prescribed among Asians, Blacks, Hispanics, and Whites (F--7,352, P < 0.01). The ethnic differences in prescribed analgesic persisted after controlling for age, gender, pre-operative use of narcotics, pain site, and insurance status. Patient's ethnicity has a greater impact on the amount of narcotic prescribed by the physician than on the amount of narcotic self-administered by the patient.

What Factors are Associated with a Second Opioid Prescription after Treatment of Distal Radius Fractures with a Volar Locking Plate?

“…These ideas merit additional study. Our findings are in line with previous published studies that note a higher postoperative opioid consumption in men [20,21] and patients who used opioids preoperatively [21]. The reason for a higher opioid consumption in men is unclear and might be related to a difference in effectiveness [22] but is also ascribed to sex differences in fear of addiction, previous pain experience, and tolerance to postoperative pain and opioid side effects [20].…”

Defining Racial and Ethnic Disparities in Pain Management

“…Comparable racial/ethnic inequalities in receipt of opioid analgesics for acute pain, but not nonopioid analgesics, have been observed for different presenting complaints, including musculoskeletal pain and back pain [42,43,55]. Examination of the literature concerning postoperative care shows, irrespective of study design, surgical procedure investigated, patient age, or whether or not patient-controlled analgesia was administered, whites received higher doses of opioid analgesics than African Americans, non-Hispanic whites, or Asian Americans [62,72,73] or were more likely to receive analgesic medications adequate to their pain level [64]. More distressing, Jimenez et al [47] reported differences in perioperative analgesic prescribing between Latino and white children who had a tonsillectomy/adenoidectomy.…”

Race and Unequal Burden of Perioperative Pain and Opioid Related Adverse Effects in Children

“…5 Though these studies 6,9,23 suggest that there is under treatment of African American patients leading to inadequate pain control, our study indicates that African American children have intrinsically higher morphine requirements for comfort after surgery. African American children had higher postoperative pain scores in the PACU after receiving identical morphine doses to Caucasian children.…”

“…Specifically, considerable evidence exists that African American and Hispanic patients report lower tolerance for experimentally induced pain compared with Caucasian adults. [2][3][4] In addition, several studies have revealed evidence of disparities in the prescription of opioid analgesics among racial and ethnic groups in the management of postoperative, 5 cancer, 6 and emergency department [7][8][9] pain in patients across all ages, including children.…”