Oct 20, 2024 Story by: Editor
New research suggests that Black patients are less likely than their White counterparts to receive multimodal analgesia, a pain management approach using multiple medications, after major surgeries. This approach is more effective and to reduce reliance on opioids. However, the study, presented at the American Society of Anesthesiologists’ annual meeting in Philadelphia, found that Black patients are more often prescribed opioids alone, despite the benefits of multimodal analgesia.
“Multimodal analgesia means using medicines and techniques that act in different ways to reduce pain. By combining different modes, patients get better pain relief and require less narcotics,” said Dr. Nauder Faraday, a professor at Johns Hopkins University and a study co-author. Dr. Faraday recommended that patients inquire with their doctors before and after surgery to understand how their pain will be managed and to confirm the medications they will be prescribed.
The study analyzed the post-surgery care of 482 Black and 2,460 White adults who underwent thoracic or abdominal surgeries at Johns Hopkins Hospital from July 2016 to July 2021. Black patients were found to be 74% more likely than White patients to receive opioids and 29% less likely to receive multimodal analgesia using four or more methods. Dr. Faraday added, “We expected most patients in both races would receive multimodal analgesia… we hypothesized that Black patients would receive less multimodal analgesia than White patients, and we found that as well.”
These findings underscore the potential racial disparities in pain management practices, though further research is needed to examine if these differences are seen among other racial and ethnic groups.
Dr. Eli Carrillo, an emergency physician at Stanford Medicine who was not involved in the study, pointed out that additional data on patients’ self-reported pain levels would have added more insight. “One thing that is a little bit different about this abstract is, it didn’t quite address pain levels,” he noted. Dr. Carrillo also highlighted that enhanced recovery protocols, like ERAS, aim to minimize opioid use but it would be valuable to know if patients were given opioids despite being part of such protocols.
Previous studies echo these findings. In a 2007 report in the Journal of the National Medical Association, it was found that physicians were twice as likely to underestimate pain in Black patients than in other ethnicities. Another study from 2016 in the Proceedings of the National Academy of Science discovered that some medical students held false beliefs about Black patients, including that Black individuals have thicker skin or less sensitive nerve endings.
An anesthesiologist based in Illinois, Dr. Dionne Ibekie, echoed the need for systemic changes in medical care, emphasizing the issue of unconscious bias. “Unfortunately, medical racism is a thing, primarily in the area of unconscious bias,” she noted, adding that bias in pain treatment is prevalent across various medical fields, from emergency care to surgery. Dr. Ibekie advocates explaining multimodal analgesia to her patients before surgery. “That way we reduce the amount of opioid medications we need to use because of their side effects… all of the medications work synergistically to address pain,” she said.
Another related study presented at the anesthesiology meeting found that Black and Hispanic trauma patients are less likely than White patients to receive airlifted transport to a hospital, despite data showing that helicopter transport can reduce mortality for severely injured patients. “Despite the clear survival benefit of helicopter transport following severe trauma, minority patients are less likely to be airlifted than White patients,” the researchers stated. They argued that these persistent disparities indicate a need for policy changes to ensure equitable access to life-saving care.
These findings reflect broader healthcare inequalities, as a recent KFF survey revealed that 15% of Black patients who accessed healthcare in the past three years felt they were denied necessary pain medication, compared to lower rates reported by patients of other ethnicities. As research continues to highlight these disparities, experts are urging healthcare providers and institutions to address and reduce racial biases in treatment decisions. Source: CNN Health
