• Basmah Safdar, Alan Heins, Peter Homel, James Miner, Martha Neighbor, Paul DeSandre, Knox H Todd, and Pain and Emergency Medicine Initiative Study Group.
• Department of Surgery, Yale University, New Haven, Connecticut 06520, USA. basmah.safdar@yale.edu
• Pain Med. 2009 Mar 1; 10 (2): 364-72.

ObjectivePain is a complex experience influenced by factors such as age, race, and ethnicity. We conducted a multicenter study to better understand emergency department (ED) pain management practices and examined the influence of patient and provider gender on analgesic administration.DesignProspective, multicenter, observational study.SettingConsecutive patients, >or=8-years-old, presenting with complaints of moderate to severe pain (pain numerical rating scale [NRS] > 3) at 16 U.S. and three Canadian hospitals.Outcomes MeasuresReceipt of any ED analgesic, receipt of opioids, and adequate pain relief in the ED.ResultsEight hundred forty-two patients participated including 56% women. Baseline pain scores were similar in both genders. Analgesic administration rates were not significantly different for female and male patients (63% vs 57%, P = 0.08), although females presenting with severe pain (NRS >or=8) were more likely to receive analgesics (74% vs 64%, P = 0.02). Female physicians were more likely to administer analgesics than male physicians (66% vs 57%, P = 0.009). In logistic regression models, predictors of ED analgesic administration were male physician (odds ratio [OR] = 0.7), arrival pain (OR = 1.3), number of pain assessments (OR = 1.83), and charted follow-up plans (OR = 2.16). With regard to opioid administration, female physicians were more likely to prescribe opioids to females (P = 0.006) while male physicians were more likely to prescribe to males (P = 0.05). In logistic regression models, predictors of opioids administration included male patient gender (OR = 0.58), male patient-physician interaction (OR = 2.58), arrival pain score (OR = 1.28), average pain score (OR = 1.10), and number of pain assessments (OR = 1.5). Pain relief was not impacted by gender.ConclusionProvider gender as opposed to patient gender appears to influence pain management decisions in the ED.

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