Black patients more likely to receive 'opioids only' pain relief after surgery

Introduction

The discrepancy in pain management between Black and White patients has been a long-standing issue, with numerous studies highlighting the racial disparities in the prescription of analgesics, particularly opioids. Recently, a study revealed that after surgery, Black patients are significantly more likely to receive only opioids for post-operative pain relief, rather than a comprehensive multimodal analgesia approach. This finding underscores the ongoing issue of inadequate pain management for Black patients and raises serious concerns about the systemic barriers and biases that contribute to this disparity.

The Current State of Pain Management Disparities

Pain management is a critical aspect of healthcare, especially post-surgery. However, the way pain is managed can vary significantly based on a patient’s race. Research has consistently shown that Black patients are less likely to receive adequate pain relief compared to their White counterparts. For instance, a study published in the Journal of Clinical Oncology found that Black and Hispanic patients nearing the end of life with cancer were less likely to receive necessary opioid medications for pain control, even when controlling for factors like income level and place of residence.

Another study revealed that Black patients with acute pain were prescribed opioids at a lower rate than White patients in emergency departments, despite similar chief concerns. These disparities are not limited to emergency settings; they extend to chronic pain management as well. Black patients with chronic pain are often underprescribed opioids, and when they are prescribed, the dosages are typically lower than those given to White patients.

The Problem of Opioids Only

The recent study highlighted the issue that Black patients are more likely to receive only opioids for post-surgical pain management. This approach, known as "opioids only," can be problematic because it relies heavily on a single class of medications that have significant risks, including addiction and overdose. In contrast, a multimodal analgesia approach involves using a combination of different medications and techniques to target pain through various mechanisms, which can lead to improved pain relief and reduced reliance on narcotics.

Why Multimodal Analgesia Matters

Multimodal analgesia is not just a better approach for managing pain; it is also safer. By using a variety of medications and techniques, healthcare providers can minimize the reliance on opioids, which are highly addictive. For example, researchers have shown that a combination of medications such as acetaminophen, NSAIDs, and local anesthetics can be highly effective in managing post-surgical pain without the need for opioids.

Barriers to Comprehensive Pain Management

Despite the evidence supporting multimodal analgesia, there are several barriers that prevent Black patients from receiving this comprehensive care. One of the primary barriers is clinician bias. Studies have shown that unconscious biases, such as the false belief that Black patients feel less pain, can lead to inaccurate pain diagnoses and treatment recommendations. These biases are often perpetuated by the lack of diversity and inclusion in medical training programs.

Another barrier is the lack of access to pain management specialists. Black patients are less likely to be referred to pain specialists compared to their White counterparts, which limits their access to advanced pain management techniques. Additionally, systemic issues such as inadequate clinician education and training, insufficient access to treatment modalities like behavioral therapy, and siloed health systems further exacerbate these disparities.

Historical Context of Racism in Pain Medicine

The issue of racial disparities in pain management is not new. It is deeply rooted in the history of racism in the United States. Historical events such as the Tuskegee study, where Black men with syphilis were intentionally withheld effective treatment, and the performance of painful procedures without anesthesia on enslaved Black women by J. Marion Sims highlight the extreme cases of medical racism. These traumas have led to a legacy of distrust among Black communities towards the healthcare system.

Moreover, everyday medical racism contributes to these disparities. Studies have shown that even when Black patients present with similar pain complaints as White patients, they are less likely to receive analgesics or opioids, leading to inadequate pain control.

Call to Action

Addressing the disparities in pain management for Black patients requires a multifaceted approach. It involves not only improving clinician training and awareness of biases but also implementing systemic changes within healthcare institutions. Here are some steps that can be taken:

• Diversity and Inclusion: Promoting racial diversity among clinicians and staff can help reduce biases and improve the patient experience. Including experiences that counter unconscious biases, such as interactions with highly respected Black people, can be beneficial.

• Comprehensive Training: Integrating strategies to reduce implicit bias into pain medicine training programs is crucial. This includes interactive experiences designed to challenge personal biases and promote empathy towards diverse patient populations.

• Systemic Changes: Healthcare institutions must actively identify and address structures that favor White patients over Black patients. This includes recognizing how algorithms used for identifying complex care needs may inadvertently disadvantage Black patients due to differences in healthcare costs.

Conclusion

The disparity in pain management for Black patients is a serious issue that requires immediate attention. By understanding the historical context of racism in medicine and addressing systemic barriers, we can work towards providing equitable care for all patients. Implementing multimodal analgesia and improving clinician training are critical steps towards ensuring that every patient receives the best possible care, regardless of their race. It is time for healthcare providers and policymakers to acknowledge the problem and take concrete actions to address it.

References

• Racial and Ethnic Disparities in Emergency Department Analgesic Prescriptions. PMC1448154.
• Racism in Pain Medicine: We Can and Should Do More. Mayo Clinic Proceedings.
• Disparities in Opioid Access for Cancer Pain at End of Life. NCI Cancer Currents Blog.
• CDC Clinical Practice Guideline for Prescribing Opioids for Pain. CDC MMWR.
• Black patients less likely to receive certain pain relief post-surgery. CNN Health News.