Highlights
- •Providers rated Black pediatric patients as more distressed by pain.
- •Providers rated Black pediatric patients as experiencing more pain interference.
- •Providers were more likely to recommended opioids to Black pediatric patients.
- •Providers rated female pediatric patients as more distressed by pain.
- •Providers did not recommend different pain treatments based on patient gender.
Abstract
Previous studies have documented that racial minorities and women receive poorer pain
care than their demographic counterparts. Providers contribute to these disparities
when their pain-related decision-making systematically varies across patient groups.
Less is known about racial and gender disparities in children with pain or the extent
to which providers contribute to these disparities. In a sample of 129 medical students
(henceforth referred to as "providers"), Virtual Human methodology and a pain-related
version of the Implicit Association Test (IAT) were used to examine the effects of
patient race/gender on providers’ pain assessment/treatment decisions for pediatric
chronic abdominal pain, as well as the moderating role of provider implicit pain-related
race/gender attitudes. Findings indicated that providers rated Black patients as more
distressed (mean difference [MD] = 2.33, P < .01, standard error [SE] = .71, 95% confidence interval [CI] = .92, 3.73) and as
experiencing more pain-related interference (MD = 3.14, P < .01, SE = .76, 95% CI = 1.63, 4.64) compared to White patients. Providers were more
likely to recommend opioids for Black patients than White patients (MD = 2.41, P < .01, SE = .58, 95% CI = 1.05, 3.76). Female patients were perceived to be more distressed
by their pain (MD = 2.14, P < .01, SE = .79, 95% CI = .58, 3.70) than male patients, however there were no gender
differences in treatment recommendations. IAT results indicated that providers held
implicit attitudes that Black Americans (M = .19, standard deviation [SD] = .29) and
males (M = .38, SD = .29) were more pain-tolerant than their demographic counterparts;
however, these implicit attitudes did not significantly moderate their pain assessment/treatment
decisions. Future studies are needed to elucidate specific paths through which the
pain experience and care of children differ across racial and gender groups.
Perspective
Providers’ pain assessment (ie, pain distress/pain interference) and treatment (ie,
opioids) of pediatric pain differs across patient race and to a lesser extent, patient
gender. This study represents a critical step in research on pain-related disparities
in pediatric pain.
Keywords
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Article info
Publication history
Published online: July 27, 2019
Accepted:
July 16,
2019
Received in revised form:
July 8,
2019
Received:
March 13,
2019
Footnotes
Disclosures: The authors have nothing to disclose. We confirm that no closely related manuscripts have been submitted for simultaneous consideration to this or another journal. There are no conflicts of interest that might be seen as influencing or prejudicing the research. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2019 by United States Association for the Study of Pain, Inc.
