How to get better pain treatment in the ER?

I have a problem with pain management. Ordinary otc pain medication doesn’t work well, and often regular doses of pain shots don’t have enough effect. But I formed a helpful hypothesis this fall in an ER and then subsequently in the hospital. I hope it works for others not getting enough pain relief. What I learned is that the magic number is 7 (SEVEN). It is very standard practice to ask one to rank one’s pain from 0 to 10. A few quick tests indicated that at 7 and above one gets codeine; below that you are in the tylenol region.

I’m white, so it may not help with the following shocking problem reported in the NYT, but the authors of the relevant studies say that communication may be a central problem:

White patients receive more pain treatment in emergency rooms than African-Americans and other minorities, a new study reports.

Researchers studied four years of data collected nationwide by the Centers for Disease Control and Prevention. They used a sample of 6,710 visits to 350 emergency rooms by patients 18 and older with acute abdominal pain.

White and black patients reported severe pain with the same frequency — about 59 percent. But after controlling for age, insurance status, income, degree of pain and other variables, the researchers found that compared with non-Hispanic white people, non-Hispanic blacks and other minorities were 22 percent to 30 percent less likely to receive pain medication. Patients were also less likely to receive pain medicine if they were over 75 or male, lacked private insurance or were treated at a hospital with numerous minority patients. The study is in the journal http://journals.lww.com/lww-medicalcare/Abstract/2015/12000/Analgesic_Access_for_Acute_Abdominal_Pain_in_the.3.aspx. …

The journal linked to gives one only the abstract, but that makes available a good sense of the studies and their scope. And the urgency of the problem.

12 thoughts on “How to get better pain treatment in the ER?

  1. “The senior author, Dr. Adil H. Haider, the director of the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston, said: ‘It may be that different people communicate differently with their providers. If we as providers could improve our ability to better communicate with patients so that we could provide more patient-centered care….'”

    I have no idea what is being suggested here about the role of “communication” in explaining racial disparities in E.R. pain treatment. Occam’s Razor would suggest that racial bias is the central problem.

  2. I was explicitly told that 5 was the charm. I got hit by a car while biking, taken to the trauma center, and they kept asking me for numbers. I wasn’t in pain, so I said, 1, 2, 1, etc. Finally a nurse said: ‘say 5 and we can give you something for the pain’. So I said 5. I wasn’t in pain, but I wanted to try out the drug–and in any case they seemed to want me to give a higher number.

  3. Hbarber, what actually I was interested in was serious narcotics. I had had two wretched experiences previously, at different hospitals. Together they had convinced me that empathy for patients in pain was generally low. I’m not sure whether there’s a gap for the ‘something for pain’ in your experience and the serious narcotic I was looking for.
    Let me just say that the earlier experiences were actually ghastly. During one I was wondering whether pain so severe could leave me psychologically damaged. Now I think that people in control of pain meds may discount a lot of complaints about pain.

  4. Anon, really good worry. Having myself failed to raise the roof in earlier expriences, I’d be prepared to believe there are cultural obstacles to complaining sufficiently. But I haven’t anything liketheexperience to back this up.

  5. I got morphine in an IV. I suspect because I looked really beat up–my lip split all the way up to my nose and gash on my forehead they had to sew up, and broken bone in my foot. I think medical personnel are generally puritanical jerks though (they will never prescribe diet pills!) so I can imagine how they’d have behaved if I weren’t covered in blood and spitting out teeth.

  6. Morphine in an IV for a 5?!? Sounds indulgent to me, but your bike experinc sounds so painful. Maybe they thought you were in shock and would be in much mor pain soon.

  7. BD, I’m wondering if you are thinking about pain management or racism in medicine. Here are two articles about racism:

    http://www.nejm.org/doi/full/10.1056/NEJMp1500832

    Burgess, D., Ryn, M. v., Dovidio, J., & Somnath Saha. (2007). Reducing Racial Bias Among Health Care Providers: Lessons from Social-Cognitive Psychology. Journal of General Internal Medicine, 22(682-887).

    One aspect of having trouble with pain meds is being a very rapid metabolizer, though I think there are some disagreements about this. One line is that with very rapid metabolizers, their systems whip through the pain medication with the result that either they experience less relief or even no relief. With a recent knee replacement, I was given an spinal that, the doctor said, would last 30 hours. It lasted 9. The nurse in charge of my meds decided that since I was dizzy when I woke up, I should only have half the amount of pain medications the doctor prescribed. This all was unpleasant.

    You could google about pain sensitivity and very rapid metabolizers.

  8. Anne, thanks for the link. I meant to indicate my interest in your point about pain management as a specific instance of bias in medical treatment, so anything relating to bias is helpful. Since I’ve been told that many of my students will be planning to pursue careers in healthcare, I would be especially interested in any resources with specific recommendations for how workers and decision makers in such fields can try to identify and address the source of these biases.

  9. BD, I hope others chime in. One book by leading researchers looks very good:
    http://www.amazon.com/Blindspot-Hidden-Biases-Good-People-ebook/dp/B004J4WJUC/ref=pd_sim_351_1?ie=UTF8&dpID=41P9UprRLoL&dpSrc=sims&preST=_AC_UL160_SR107%2C160_&refRID=10W88N9YT16MTS6D353Q
    And Jennifer Saul has an excellent paper on implicit biases linked to on her homepage at Sheffield.

    I,d suggest these sources for learning about bias before they tackle specific minority bias in medical contexts. Bias in medical contexts is a hot topic right now, thank goodness, and googling “Medicine bias” brought up lots of relevant resources. The NY Times has a lot of stuff. John Dividio has been anexcellent researcher in the area. There’s a very interesting book by a black doctor named ‘white’. It shouldn!t be hard to find on amazon. Just try ‘medicine bias black biography.’

  10. That’s a very interesting study. I’ve always said “9” when they’ve asked, since I’ve been very confident that that way I can get what Prof. Jacobson calls “serious narcotics”. (We’re talking about morphine and related opiates, I take it.) 10 seems like exaggeration and anything less than 9, I’ve feared, would have risked them giving me OTC painkillers. Now I have a new reason to keep saying “9”!

  11. In case anyone else is interested in bioethics readings on racial disparities in healthcare, a colleague just sent me this suggestion, which looks promising. The article discussed is “Debating the Cause of Health Disparities: Implications for Bioethics and Racial Equality” by Dorothy Roberts, but it also includes suggestions for several related articles.

    http://diversifyingsyllabi.weebly.com/uploads/3/8/1/8/38180217/diversifying_syllabi_handout_roberts.pdf

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