A study released Monday shows that Black children are given less painkillers than white children when being treated for acute appendicitis, an extremely painful inflammation of the appendix. While several studies have looked at the racial disparity in pain management among adults, this study focuses on the phenomenon among children. And it turns out that both Black children and Black adults can look forward to racial bias and racist treatment when seeking medical attention.
The article published online by JAMA Pediatrics on Monday presents a study which used data from the National Hospital Ambulatory Medical Care Survey from 2003 to 2010 to look at the use of opioid analgesia (which includes medications like Percocet ) and nonopioid analgesia (which includes over the counter household medicine like Tylenol).
Of an estimated almost 1 million children evaluated in Emergency Departments (EDs) who were diagnosed with appendicitis, 56.8 percent of patients received some for of analgesia and 41.3 percent received opioid analgesia. Among the patients with moderate pain, Black children were less likely to receive any analgesia than white children. Among the patients with severe pain, Black children were less likely to receive opioids(12.2 percent) than white children (33.9 percent.)
According to the study,
Our findings suggest that there are racial disparities in opioid administration to children with appendicitis, even after adjustment for potential confounders. More research is needed to understand why such disparities exist. This could help inform the design of interventions to address and eliminate these disparities and to improve pain management for all youths.
… although clinicians may recognize pain equally across racial groups, they may be reacting to the pain differently by treating black patients with nonopioid analgesia, such as ibuprofen and acetaminophen, while treating white patients with opioid analgesia for similar pain.”
Eric W. Fleegler, M.D., M.P.H., and Neil L. Schechter, M.D., of Boston Children’s Hospital and Harvard Medical School, Boston, asked in an editorial about the study,
How do we explain the persistence of these disparities in treatment? … If there is no physiological explanation for differing treatment of the same phenomena, we are left with the notion that subtle biases, implicit and explicit, conscious and unconscious, influence the clinician’s judgment. … It is clear that despite broad recognition that controlling pain is a cornerstone of compassionate care, significant disparities remain in our approach to pain management among different populations. Strategies and available knowledge exist to remedy this unfortunate situation; we can and should do better.
Sadly, they write, the results of the study are hardly surprising: “Unfortunately, however, these findings fit a longstanding pattern. There is a substantial body of evidence documenting health care disparities during the past three decades, including disparities in pain management.”
Surely, the possibility of side effects, complications and addictions are stronger with opioids than non-opioids. But that is irrelevant for this study. The issue is why more is done to relieve the pain of white children than to relieve the pain of Black children. Possible reasons include anything from the racist belief, on an unconscious or conscious level, that Black people are stronger, have higher pain tolerance, are physiologically more addiction-prone, or even deserve to feel pain or have less of a right to pain relief than white children.
This story is disturbing and newsworthy in itself, but it’s also a great thing to show your friends or family members who like to pretend that racism is over or that we live in a post-racial world. Though most of the people who say that don’t really respond well to facts or reality. So, choose your battles.