The Role of Ethnicity in Pain Tolerance and Treatment

A study in the British Journal of Pain examined ethnic differences in pain tolerance and came to a strong, perhaps not so shocking, conclusion.

Pain response across ethnicities is a sensitive and tangled topic. Previous US studies have raised the troubling issue that patients from African American, Asian and minority ethnic (BAME) groups tend to receive less analgesics compared to Caucasian patients after similar surgical procedures, suggesting that healthcare professionals may perceive the expression of excessive pain by BAME patient groups as an exaggerated response to pain, rather than sub-optimal treatment. This perception could lead to under-treatment of pain.

“Poorly treated acute pain predisposes to chronic pain and its associated psychological burden, neuronal plasticity and delayed mobility and recovery,” the study authors explained. “The exploration of any factor that may cause disparities in analgesic provision between different patient groups is essential to minimize the risk of under treatment and minimize the burden of chronic pain on patients…”

The authors raised the important distinction between “race” and “ethnicity;” the former refers to a patient’s descent, ancestry, and physical characteristics, while the latter includes behavioral, cultural, social, and psychological background. The geographic area of this study — Leicester, England – has a population that includes 28% from Indian ethnicity, and a representative proportion of minority healthcare professionals.

The study was a retrospective case note review of acute post-operative pain after total abdominal hysterectomy (TAH) in 60 South Asian and 60 age-matched White British females. Data for 140 variables (pre-, intra- and post-operative) for each patient were recorded. The researchers used propensity score matching to produce 30 closely matched patients in each group, minimizing effects of recorded co-variates. There were no significant differences in acute post-operative pain scores, morphine requirements, pain management, adverse effects or duration of post-operative care unit stay between South Asian and White British patients. The median duration of hospital stay of South Asian patients was longer (4.5&thinsp;days versus 3.0&thinsp;days, p&thinsp;<&thinsp;0.001), but the majority of all patients left the hospital within the usual timeframe.

“While we did not identify significant differences in acute post-operative pain management between patient groups, we did observe some differences in early post-operative respiratory rates,” the researchers noted. “These differences in respiratory rates may explain our local health-care professionals’ prior perception that South Asian patients are more ‘sensitive’ to the respiratory depressant effects of opioids. However, after propensity score matching, there were no significant differences in respiratory rates…Our data suggest that in a population with a large proportion of BAME patients, and an institution employing health-care professionals from diverse ethnic backgrounds, ethnicity does not have a major influence on pain assessment and treatment.”

Caution should be expressed in extrapolating these results in view of the size of this study and the multicultural nature of both the patients and health-care professionals in Leicester, the authors advised.