• Kristin Drogell, Brianna Kincade, Mikhail Melaku, Caroline Mangira, Andrew Burns, and Jessica Krizo.
• Department of Emergency Medicine, Cleveland Clinic Akron General Medical Center, Akron, Ohio.
• J Emerg Med. 2022 Nov 1; 63 (5): 629635629-635.

BackgroundPain management is critical to the management of patients in the emergency department (ED). The clinical decision-making process for prescribing medications is complicated by its subjective nature. Historically, racial and ethnic minority groups and women have not had their pain managed as aggressively as White and male patients.ObjectiveThe objective of this study was to determine whether race and biological sex affect the pain management process by means of evaluating data from a large hospital system with diverse patient demographic characteristics.MethodsThis was a retrospective study of adult patients who presented an ED within the hospital system and were discharged from the ED with a diagnosis of undifferentiated abdominal pain during a single year. Patient pain was classified as mild, moderate, or severe, and patients were further stratified by race, ethnicity, sex, and insurance status. Pain management was assessed by narcotic vs non-narcotic administration.ResultsA total of 32,676 patients were included in the study. Narcotic administration was more likely in White patients with undifferentiated abdominal pain (22%) compared with Black patients (12%; adjusted odds ratio 0.50; 95% CI 0.46-0.54). This persists across patient-reported pain scores. In addition, women (16.99%) were prescribed narcotics less often than men (19.41%; p < 0.0001).ConclusionsAlthough differences in pain management practices have been explored previously, this study provided a large, updated, multifacility assessment that confirmed that race- and sex-based differences in pain management persist, specifically in the decision to treat with narcotics. Further investigation is warranted to determine the root causes of these differences.Copyright © 2022 Elsevier Inc. All rights reserved.

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