Advertisement
Minorities & Adnominal Pain Care in EDs

Minorities & Adnominal Pain Care in EDs

Acute abdominal pain is one of the most common reasons for patients to visit the ED, but few studies have examined if there are racial and ethnic disparities for how this pain is managed. Prior research focusing on the management of acute abdominal pain in the ED setting has yielded conflicting results. Adil H. Haider, MD, MPH, FACS, and colleagues had a study published in Medical Care that sought to gain a better understanding of the potential racial and ethnic differences in the use of analgesics in the ED to manage this pain. Using data from the CDC’s National Hospital Ambulatory Medical Care Survey, the investigators analyzed patients aged 18 and older who were seen for non-traumatic abdominal pain at 350 EDs over a span of about 5 years across the United States. Of the more than 6,700 ED visits included in the analysis, 61.2% of the patients were white, 20.1% were black, 14.0% were Hispanic, and 4.7% belonged to other racial or ethnic groups. The study group compared rates of analgesic medication use among these racial and ethnic groups, and then accounted for differences in patient and hospital characteristics.   Observed Disparities According to the results, white patients were most likely to receive any analgesic medication (56.8%) when compared with Hispanic patients (52.8%), black patients (50.9%), and people who were classified as other racial or ethnic groups (46.6%). “Black patients were the least likely to receive narcotic analgesics despite having similar rates of severe pain as other racial and ethnic groups,” says Dr. Haider. After adjusting for other factors, blacks, Hispanics, and patients of other races and ethnicities...

Acute Pain Management in the ED

Pain has been identified as the most common reason for patients seeking care in emergency rooms. Considering the substantial impact that pain has on patients, ED physicians need to be well versed in its management, particularly in acute pain situations. Unfortunately, research has shown that ED physicians often fail to provide adequate analgesia to their patients. There are also challenges in meeting patients’ expectations in treating pain and in changing prescribing patterns of opioid analgesics. The Effects of “Oligoanalgesia” We have more than 25 years of research on acute pain management as well as multiple guidelines on the topic. Despite this information, the phenomenon of “oligoanalgesia”— the undertreatment of pain—continues to persist in EDs. The following are major causes of oligoanalgesia in the ED: Lack of basic knowledge and formal education on acute pain management. Prejudice toward and irrational fear of using opioids in the ED. Lack of adherence to acute pain management guidelines and clinical pathways. Underuse of analgesics titration protocols. Barriers preclude ED physicians from proper acute pain management that include ethnic, racial, and age bias as well as ED environment and culture. Wanted: More Formal Pain Management Training The lack of formal teaching of acute pain management in medical schools has had a profound effect on the gap in emergency physicians’ clinical knowledge on the subject. There may also be a reluctance to change practice patterns or a prejudice toward using opioid analgesics in the ED. Pain management is a subject that is not taught within most medical school programs. Research has shown, however, that utilizing pain management educational programs can lead to substantial improvements (see...

Long-Term Use of Analgesic After Surgery

An investigation of older, opioid-naïve patients who were given an opioid within 1 week of a short-stay surgery has found that this population appears to be frequently prescribed analgesics immediately after ambulatory surgery, a practice that appeared to be associated with long-term use. Patients who received an opioid prescription within 1 week were 44% more likely to become long-term opioid users within 1 year when compared with those not prescribed an opioid. Those who received an NSAID prescription within 1 week were nearly four times more likely to become long-term NSAID users when compared with those not prescribed these drugs. Abstract: Archives of Internal Medicine, March 12,...
[ HIDE/SHOW ]