Disparities in Pain Management in the Emergency Department: An Integrative Review

Abstract

Purpose: The purpose of this integrative review is to investigate the degree of variability in the prescribing approaches to acute pain management in the emergency department (ED) setting. Variations in analgesic prescribing among ethnic and racial minorities as they compare to non-minority patients with similar complaints of pain will be examined. Data Sources: A comprehensive review of the literature was conducted using MEDLINE, PubMed, and CINAHL databases. Inclusion criteria of the studies were: US studies; published between 2002 and 2012; English language; with at least one aim or analysis comparing prescription of analgesia between a racial or ethnic minority and non-minority group in the ED. Key words used to obtain relevant articles included pain management; analgesia prescription; minority; race; ethnicity; emergency department; disparities. Conclusion: A research summary concluded that racial and ethnic disparities in pain management continue to exist in the ED setting. When compared to Caucasian patients, African American and non-white ethnicities were less likely to receive analgesia. Language barriers, experience of providers, and trust were among the contributors to pain management disparities. Implications for Practice: The role of the nurse is to incorporate cultural competence in assessing and achieving equitable pain management across all racial/ethnic groups.

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Johnson, M. , Richardson, K. and Kridli, S. (2014) Disparities in Pain Management in the Emergency Department: An Integrative Review. Open Journal of Nursing, 4, 608-619. doi: 10.4236/ojn.2014.48064.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Merriam-Webster Online Medical Dictionary (2013) Pain. www.merriam-webster.com/medical/pain
[2] Dubois, M., Gallagher, R. and Lippe, P. (2009) Pain Medicine Position Paper. Pain Medicine, 10, 972-1000.
http://dx.doi.org/10.1111/j.1526-4637.2009.00696.x
[3] Gindi, R., Cohen, R. and Kirzinger, W. (2012) Emergency Room Use among Adults Aged 18-64: Early Release of Estimates from the National Health Interview Survey, January-June 2011. National Center for Health Statistics. May 2012.
http://www.cdc.gov/nchs/nhis/releases.htm.
[4] National Ambulatory Medical Care Survey (2009) National Ambulatory Medical Care Survey: 2009 Emergency Department Summary Tables.
http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2009_ed_web_tables.pdf
[5] Centers for Medicare and Medicaid Services (2012) Emergency Medical Treatment and Labor Act (EMTALA).
http://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html
[6] Hadley, J. and Cunningham, P. (2004) Availability of Safety Net Providers and Access to Care of Uninsured Persons. Health Services Research, 39, 1527-1546.
http://dx.doi.org/10.1111/j.1475-6773.2004.00302.x
[7] May, J., Cunningham, P. and Hadley, J. (2004) Most Uninsured People Unaware of Health Care Safety Net Providers. Issue Brief Center for the Studying Health System Change, 90, 1-4.
http://www.hschange.com/CONTENT/718/
[8] Cohen, R. and Martinez, M. (2012) Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2011. National Center for Health Statistics.
http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201206.pdf
[9] Centers for Disease Control (2011) Fact Sheet—CDC Health Disparities and Inequalities Report—US 2011.
http://www.cdc.gov/minorityhealth/reports/CHDIR11/FactSheet.pdf
[10] Joint Commission on the Accreditation of Health Organizations (2012) Facts about Pain Management.
http://www.jointcommission.org/pain_management/
[11] Mossey, J. (2011) Defining Racial and Ethnic Disparities in Pain Management. Clinical Orthopaedics and Related Research, 469, 1859-1870.
http://dx.doi.org/10.1007/s11999-011-1770-9
[12] Green, C., Anderson, K.O., Baker, T.A., Campbell, L.C., Decker, S., Fillingim, R.B., et al. (2003) The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain. Pain Medicine, 4, 277-294.
http://dx.doi.org/10.1046/j.1526-4637.2003.03034.x
[13] Anderson, K., Mendoza, T.R., Valero, V., Richman, S.P., Russell, C., Hurley, J., et al. (2000) Minority Cancer Patients and Their Providers. Pain Management Attitudes and Practice. Cancer, 88, 1929-1938.
http://dx.doi.org/10.1002/(SICI)1097-0142(20000415)88:8<1929::AID-CNCR23>3.0.CO;2-2
[14] Todd, K., Deaton, C., D’Adamo, A. and Goe, L. (2000) Ethnicity and Analgesic Practice. Annals of Emergency Medicine, 35, 11-16.
http://dx.doi.org/10.1016/S0196-0644(00)70099-0
[15] Heins, J., Heins, A., Grammas, M., Costello, M., Huange, K. and Mishra, S. (2006) Disparities in Analgesia and Opioid Prescribing Practices for Patients with Musculoskeletal Pain in the Emergency Department. Journal of Emergency Nursing, 32, 219-224.
http://dx.doi.org/10.1016/j.jen.2006.01.010
[16] Anderson, K., Green, C. and Payne, R. (2009) Racial and Ethnic Disparities in Pain: Causes and Consequences of Unequal Care. The Journal of Pain, 10, 1187-1204.
http://dx.doi.org/10.1016/j.jpain.2009.10.002
[17] Miner, J., Biros, M., Trainor, A., Hubbard, D. and Beltram, M. (2006) Patient and Physician Perceptions as Risk Factors for Oligoanalgesia: A Prospective Observational Study of the Relief of Pain in the Emergency Department. Academic Emergency Medicine, 13, 140-146.
http://dx.doi.org/10.1111/j.1553-2712.2006.tb01662.x
[18] Staton, L.J., Panda, M., Chen, I., Genao, I., Kurz, J., Pasanen, M., Mechaber, A.J., Menon, M., O’Rorke, J., Wood, J., Rosenberg, E., Faeslis, C., Carey, T., Calleson, D. and Cykert, S. (2007) When Race Matters: Disagreement in Pain Perception between Patients and Their Physicians in Primary Care. Journal of the National Medical Association, 99, 532-538.
[19] Tamayo-Sarver, J., Dawson, N., Hinze, S., Cydulka, R., Wigton, R., Albert, J., Ibrahim, S. and Baker, D. (2003) The Effect of Race/Ethnicity and Desirable Social Characteristics on Physicans’ Decisions to Prescribe Opioid Analgesics. Academic Emergency Medicine, 10, 1239-1248.
http://dx.doi.org/10.1111/j.1553-2712.2003.tb00608.x
[20] Kposowa, A. and Tsunokai, G. (2002) Searching for Relief: Racial Differences in Treatment of Patients with Back Pain. Race & Society, 5, 193-223.
http://dx.doi.org/10.1016/j.racsoc.2004.01.004
[21] Siddall, P. and Cousins, M. (2004) Persistent Pain as a Disease Entity: Implications for Clinical Management. Anesthesia and Analgesia, 99, 510-520.
http://dx.doi.org/10.1213/01.ANE.0000133383.17666.3A
[22] European Federation of International Association for the Study of Pain (2001) Declaration on Chronic Pain as a Major Healthcare Problem, a Disease in Its Own Right.
http://efic.org/index.asp?sub=724B97A2EjBu1C
[23] Riley, J. and King, C. (2009) Self-Report of Alcohol Use for Pain in a Multi-Ethnic Community Sample. Journal of Pain, 10, 944-952.
http://dx.doi.org/10.1016/j.jpain.2009.03.005
[24] Brennan, F., Carr, D. and Cousins, M. (2007) Pain Management: A Fundamental Human Right. Anesthesia and Analgesia, 105, 205-221.
http://dx.doi.org/10.1213/01.ane.0000268145.52345.55
[25] Cooper, H. (1984) The Integrative Research Review: A Systematic Approach. Sage, Beverly Hills.
[26] Cooper, H. (1982) Scientific Guidelines for Conducting Integrative Research Reviews. Review of Educational Research, 52, 291-302.
http://dx.doi.org/10.3102/00346543052002291
[27] Cooper, H. (1998) Synthesizing Research: A Guide for Literature Reviews. 3rd Edition, Sage, Thousand Oaks.
[28] Whittemore, R. and Knafl, K. (2005) The Integrative Review: Updated Methodology. Journal of Advanced Nursing, 52, 546-553.
http://dx.doi.org/10.1111/j.1365-2648.2005.03621.x
[29] Pletcher, M., Kertesz, S., Kohn, M. and Gonzales, R. (2008) Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments. Journal of American Medical Association, 299, 70-78.
http://dx.doi.org/10.1001/jama.2007.64
[30] Platts-Mills, T., Esserman, D., Brown, L., Bortsov, A., Sloane, P. and McLean, S. (2012) Older US Emergency Department Patients Are Less Likely to Receive Pain Medication than Younger Patients: Results from a National Survey. Annals of Emergency Medicine, 60, 199-206.
http://dx.doi.org/10.1016/j.annemergmed.2011.09.014
[31] Stetler, C., Morsi, D., Rucki, S., Broughton, S., Corrigan, B., Fitzgerald, J., Giuliano, K., Havener, P. and Sheridan, E. (1998) Utilization-Focused Integrative Reviews in a Nursing Service. Applied Nursing Research, 11, 195-206.
http://dx.doi.org/10.1016/S0897-1897(98)80329-7
[32] Yen, K., Kim, M., Stremski, E. and Gorelick, M. (2003) Effect of Ethnicity and Race on the Use of Pain Medications in Children with Long Bone Fractures in the Emergency Department. Annals of Emergency Medicine, 42, 41-47.
Http://Dx.Doi.Org/10.1067/Mem.2003.230
[33] Hostetler, M., Auinger, P. and Szilagyi, P. (2002) Parental Analgesic and Sedative Use among ED Patients in the United States: Combined Results from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 1992-1997. American Journal of Emergency Medicine, 20, 83-87.
http://dx.doi.org/10.1053/ajem.2002.31578
[34] Quazi, S., Eberhart, M., Jacoby, J. and Heller, M. (2007) Are Racial Disparities in ED Analgesia Improving? Evidence from a National Database. American Journal of Emergency Medicine, 26, 462-464.
http://dx.doi.org/10.1016/j.ajem.2007.05.007
[35] Tsai, C., Sullivan, A., Gordon, J., Kaushal, R., Magid, D., Blumenthal, D. and Camargo, A. (2012) Racial/Ethnic Differences in Emergency Care for Joint Dislocation in 53 US EDs. The American Journal of Emergency Medicine, 30, 1970-1980.
http://dx.doi.org/10.1016/j.ajem.2012.04.023
[36] Fuentes, E., Kohn, M. and Neighbor, M. (2002) Lack of Association between Patient Ethnicity or Race and Fracture Analgesia. Academic Emergency Medicine, 9, 910-915.
http://dx.doi.org/10.1111/j.1553-2712.2002.tb02192.x
[37] Mills, A., Shofer, F., Boulis, A., Holena, D. and Abbuhl, S. (2011) Racial Disparity in Analgesic Treatment for ED Patients with Abdominal or Back Pain. American Journal of Emergency Medicine, 29, 752-756.
http://dx.doi.org/10.1016/j.ajem.2010.02.023
[38] Bijur, P., Berard, A., Essess, D., Calderon, Y. and Gallagher, J. (2008) Race, Ethnicity, and Management of Pain from Long-Bone Fractures: A Prospective Study of Two Academic Urban Emergency Departments. Academic Emergency Medicine, 15, 589-597.
http://dx.doi.org/10.1111/j.1553-2712.2008.00149.x
[39] Epps, C., Ware, L. and Packard, A. (2008) Ethnic Wait Time Differences in Analgesic Administration in the Emergency Department. Pain Management Nursing, 9, 26-32.
http://dx.doi.org/10.1016/j.pmn.2007.07.005
[40] Ware, L., Epps, C., Clark, J. and Chatterjee, A. (2012) Do Ethnic Differences Still Exist in Pain Assessment and Treatment in the Emergency Department? Pain Management Nursing, 13, 194-201.
http://dx.doi.org/10.1016/j.pmn.2010.06.001
[41] Minick, P., Clark, P., Dalton, J., Horne, E., Greene, D. and Brown, M. (2012) Long-Bone Fracture Pain Management in the Emergency Department. Journal of Emergency Nursing, 38, 211-217.
http://dx.doi.org/10.1016/j.jen.2010.11.001
[42] Bijur, P., Berard, A., Nestor, J., Calderon, Y., Davitt, M. and Gallagher, E. (2007) No Racial or Ethnic Disparity in Treatment of Long-Bone Fractures. American Journal of Emergency Medicine, 26, 270-274.
http://dx.doi.org/10.1016/j.ajem.2007.05.010
[43] American College of Surgeons (2007) Consultation Verification Program.
http://www.facs.org/trauma/vcprogram.html
[44] Centers for Disease Control (2013) Ambulatory Health Care Data.
http://www.cdc.gov/nchs/ahcd.htm
[45] Sullivan, A., Carmargo, C., Cleary, P., Gordon, J., Guadagnoli, E., Kaushal, R., Magid, D., Rao, S. and Blumenthal, D. (2007) The National Emergency Department Safety Study: Study Rationale and Design. Academic Emergency Medicine, 14, 1182-1189.
http://dx.doi.org/10.1111/j.1553-2712.2007.tb02341.x
[46] Tamayo-Sarver, J., Hinze, S., Cydulka, R. and Baker, D. (2003) Racial and Ethnic Disparities in Emergency Department Analgesic Prescription. American Journal of Public Health, 93, 2067-2073.
http://dx.doi.org/10.2105/AJPH.93.12.2067
[47] Todd, K., Samaroo, N. and Hoffman, J. (1993) Ethnicity as a Risk Factor for Inadequate Emergency Department Analgesia. Journal of the American Medical Association, 269, 1537-1539.
http://dx.doi.org/10.1001/jama.1993.03500120075029
[48] Cone, D., Richardson, L., Todd, K., Betancourt, J. and Lowe, R. (2003) Health Care Disparities in Emergency Medicine. Academic Emergency Medicine, 10, 1176-1183.
http://dx.doi.org/10.1111/j.1553-2712.2003.tb00600.x

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