Race and Sex Are Associated With Variations in Pain Management in Patients Presenting to the Emergency Department With Undifferentiated Abdominal Pain

Background: Pain 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. His-torically, racial and ethnic minority groups and women have not had their pain managed as aggressively as White and male patients. Objective: The 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 demo-graphic characteristics. Methods: This 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 sin-gle year. Patient pain was classified as mild, moderate, or severe, and patients were further stratified by race, ethnic-ity, sex, and insurance status. Pain management was assessed by narcotic vs non-narcotic administration. Results: A to-tal of 32,676 patients were included in the study. Narcotic administration was more likely in White patients with un-differentiated 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 addi-tion, women (16.99%) were prescribed narcotics less often than men (19.41%; p < 0.0001). Conclusions: Although dif-ferences in pain management practices have been explored previously, this study provided a large, updated, multifa-cility assessment that confirmed that race-and sex-based differences in pain management persist, specifically in the decision to treat with narcotics. Further investigation is war-ranted to determine the root causes of these differences. (c) 2022 Elsevier Inc. All rights reserved.