Does Pain Treatment Differ by Ethnicity?

Pain is pain, regardless of the race, gender, or ethnicity of the person experiencing it. But pain treatment may not be so blind. Some studies in adult patients have shown that ethnicity and race might be associated with disparities in analgesia and opioid treatment in Emergency Department (ED) patients with limb fractures. Fortunately, a study in The Annals of Emergency Medicine suggests that ethnic differences did not make a difference in pain treatment in a pediatric ED in northern Israel.

Acute pain in children is often under-treated. This can begin in the ED, especially for children suffering from limb fractures or joint dislocations, who should in most cases be treated immediately with analgesics. The troubling question of whether ethnicity presents an obstacle to such treatment has been the subject of research in the adult population, but this is the first study to look at the potential impact of ethnicity in a pediatric ED population.

Some studies in the United States have shown that African American children in the United States with orthopedic injuries were the least likely to receive parenteral analgesia and were triaged to have longer ED waiting times compared with white children. In addition, a previous study in Israel found that ethnicity had an influence on medical staff's assessment of pain for patients undergoing labor.

The Annals study was a retrospective cohort of patients aged 3 to 15 years who received a diagnosis of a limb fracture or dislocation at Rambam Health Care Campus, the only tertiary care hospital in the north of the country. Rambam serves a population of more than 2 million patients, including Jewish and Arab patients. Data on demographics, including ethnicity, nurse ethnicity, pain level, and pain medication, were collected.

The four-year study period determined that the rate of opioid treatment for children suffering from fractures or dislocations did not differ, no matter the ethnicity of the nurse or patient, and regardless of the flare-up of Israeli-Palestinian armed conflict of 2014. No matter the pairing — Arabic nurses caring for Jewish patients, Jewish nurses caring for Arabic patients, Arabic nurses caring for Arabic patients, and Jewish nurses caring for Jewish patients – the rate of opioid care was high, consistent, and not different in any statistically significant way.

The study authors believe that strong pain protocols and nurse training at the ED, which includes human patient simulation, as well as in-hospital workshops and refresher courses throughout the year, contributed to the positive finding. One of the limitations is that this was a single-center study and may not necessarily be applicable to EDs in other parts of Israel or the world.