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Certain painkiller combinations have been found to be more effective than opioids alone in managing postoperative discomfort, but Black patients are less likely to receive this level of care during recovery from major surgery. A new study suggests that it is.
The study, presented Sunday at the American Society of Anesthesiologists’ annual meeting in Philadelphia, found that post-surgical Black patients were more likely to be prescribed oral opioids compared to white patients and were more likely to be prescribed oral opioids for pain management. patients were found to be less likely to receive multimodal analgesic therapy that included two modes of pain therapy. .
Multidisciplinary analgesia is a pain management method that uses multiple types of drugs to reduce pain, and some experts believe this approach not only reduces the use of dangerous and addictive opioids, but also , argue that it has the potential to be a more effective pain management strategy.
“Multidisciplinary analgesia means using drugs and techniques that work in different ways to reduce pain. By combining different modes, patients can get better pain relief. , the amount of narcotics needed is also reduced,” study author Dr. Nauder Faraday, a professor at Johns Hopkins University School of Medicine, said in an email.
To determine whether a patient should undergo multimodal analgesia, “Before starting surgery, ask the doctor how the pain will be managed after surgery and what medications will be prescribed. “We can do that,” Faraday said. “You can also ask your doctor the same questions after surgery.”
The new study includes data on thoracic or abdominal surgeries performed at Johns Hopkins Hospital from July 2016 to July 2021. These complex surgeries required admission to the intensive care unit within 24 hours of surgery.
Researchers at Johns Hopkins University analyzed how 482 black adults and 2,460 white adults received treatment after surgery.
The analysis found that black patients were about 74% more likely than white patients to be given opioid pills during their postoperative recovery, and being black made them more likely to receive multimodal pain therapy that included four or more modes. It was found that this was associated with a 29% lower level of gender. Faraday said the researchers found no differences when using two or three modes of analgesia, and only differences when using four or more modes.
“We expected that most patients of both races would receive multimodal pain therapy, and that’s what we found. Based on previously published studies, We hypothesized that black patients would have less complex analgesia than white patients, and we found that to be the case,” Faraday said.
The researchers said in their abstract that their findings highlight that “racial disparities may exist” in the application of combined analgesia, but other racial groups and ethnic groups He said further research is needed to determine whether similar disparities emerge between groups.
Overall, the study shows some correlation between race and pain medication administration, but “what’s a little different about this summary is that it doesn’t quite address pain level.” said emergency physician Dr. Eli Carrillo. is director of prehospital education at Stanford School of Medicine and was not involved in the new study.
Carrillo said the findings would be further enriched by data on each patient’s self-reported pain level and whether there was a difference in the amount of pain between black and white patients.
Additionally, “most postoperative pain management systems typically include a well-conceived continuum of care called ERAS, an ‘enhancement of postoperative recovery’ protocol,” Carrillo said. “So it would be interesting to know whether these patients are being given more opioids in addition to already being part of a protocol that favors non-opioid. This indicates that they were being treated outside of the standard for that institution, despite the fact that they were being treated outside of that institution’s standards. ”
Last year, Carrillo of Stanford University and his colleagues wrote a similar study published in JAMA Network Open. The study found that of the more than 4.7 million patients treated by paramedics for acute trauma, Black and brown patients were less likely to reach that level. Number of pains recorded in health data.
The researchers also found that among patients with the highest recorded pain scores, black patients were significantly less likely to receive pain medication than white patients.
“Pain treatment is important not only because it impacts quality of life, but also because risks and benefits must be considered whenever opioids are introduced,” Carrillo said.
“Understanding how to provide maximum benefit while reducing the risk of addiction and overdose is our top priority in acute or chronic pain management,” he said. “It has a direct impact on people’s lives and ability to live, and even their desire to participate in the health care system in the future.”
Dr. Dionne Ibeke, an anesthesiologist in central Illinois who was not involved in the new study, said that whenever she meets with patients before surgery, she makes sure to explain the multidisciplinary pain relief approach that will be used. Opioid and non-opioid drugs are used to treat pain.
“Doing so reduces the amount of opioid drugs you need to use because of the side effects, but also because there are other pain pathways and receptors in your body that opioids don’t act on. “We want to emphasize that all medications work synergistically to address pain and increase the likelihood of achieving adequate pain control,” he says on the podcast “The Ivy Drip” on how to limit postoperative opioids. Ibeki, who spoke, wrote in an email. .
New research suggests ‘possible bias in treatment decisions’. This once again points to the need for systemic changes in medicine and further research and policy to ensure equitable health care for all,” Ibeky wrote.
“Unfortunately, medical racism exists, primarily in the area of unconscious bias. Numerous studies have been conducted in a variety of medical fields to show that black patients are undertreated for pain. “Repeatedly, they have been found to be poorly managed or poorly managed,” she said. “From the emergency room to the maternity ward, whether it’s a Black child or an adult, or a patient with a known chronic disease like sickle cell or an acute condition like a heart attack, I We see patients suffering from missed diagnoses and inadequate pain management, resulting in adverse outcomes.”
Although this new study has not been published in a peer-reviewed journal, it is not the first time that research has uncovered deep racial inequities in health care when it comes to pain management and treatment.
A study published in the Journal of the National Medical Association in 2007 found that doctors were twice as likely to underestimate pain in Black patients compared to all other ethnicities combined.
Another study published in 2016 in the Proceedings of the National Academy of Sciences found that 222 medical students and residents held false racist beliefs about black patients. For example, about 12% reported thinking that black people’s nerve endings are less sensitive than white people’s, and about 58% reported thinking that black people’s skin is thicker than white people’s.
“Taken together, this study provides evidence that false beliefs about biological differences between blacks and whites continue to shape how we perceive and treat black people. are associated with racial disparities in assessment and treatment recommendations,” the authors of the 2016 study said. I wrote.
A KFF study on racism, discrimination, and health released last year found that 15% of black patients who sought medical care in the past three years said they were denied pain medication they thought they needed. In comparison, the rates were 8% and 9% for patients of Asian descent. 10% of white patients and 10% of Hispanic patients.
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Another study presented Sunday at the American Society of Anesthesiologists’ annual meeting suggested that Black and brown trauma patients are less likely to receive timely helicopter evacuation in medical emergencies.
Research has found that of more than 300,000 people over the age of 15 with serious injuries requiring emergency surgery or intensive care, helicopter evacuation has a lower risk of death than ground evacuation, at 17.6%. It was 19.4%. However, data showed white patients were twice as likely to be airlifted compared to black patients and nearly twice as likely to be airlifted compared to Hispanics or other races.
Researchers from Nationwide Children’s Hospital in Ohio and Montefiore Medical Center in New York found that “despite the clear survival benefits of helicopter transport after severe trauma, minority patients are less likely to be transported than white patients.” “It is also unlikely that the aircraft will be airlifted,” the summary said.
“These disparities have not begun to narrow over time, calling into question the effectiveness of current efforts to expand helicopter ambulance programs,” they wrote. “As trauma care continues to evolve, we need to ensure that access to rapid and life-saving treatments, such as helicopter transport, is not influenced by non-clinical factors such as race and ethnicity.”
