1. Mennick, Fran BSN, RN


One study found that opioid analgesic prescription rates still differ rates were particularly low among black and Hispanic children.


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Treatment of pain in EDs has improved, but inequities in pain treatment remain a public health problem. More than 42% of ED visits between 1993 and 2005 involved a report of pain, according to an analysis of data from the National Hospital Ambulatory Medical Care survey. While prescribing of opioid analgesics for pain-related visits rose from 23% in 1993 to 37% in 2005, racial disparities in analgesic prescribing have not improved. Over the 13-year study period, non-Hispanic whites were more likely to be prescribed an opioid (31%), than were blacks (23%), Hispanics (24%), and Asians or others (28%). In 2005 whites who visited the ED in pain received an opioid prescription 40% of the time, compared with 32% of all others. In contrast, nonopioid analgesia alone was prescribed for 32% of nonwhites over the study period, compared with only 26% of whites. Disparities were present regardless of the type or location of the pain and even when the patient had a fracture of a long bone or nephrolithiasis, two conditions widely acknowledged to be severely painful. Disparities actually increased as pain severity increased, and prescription rates were particularly low among black and Hispanic children.


Reasons for the disparities were not specifically studied. They may include racial biases among prescribers, but minority patients might be less assertive in complaining about pain or less likely to request opioid analgesia than whites. Efforts to achieve equity in the treatment of pain in the ED should include physician education, patient education, and nurse-initiated pain-treatment protocols, according to the study authors.

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Fran Mennick, BSN, RN


Pletcher MJ, et al. JAMA 2008;299(1):70-8.



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