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Racial Differences in Presentations and Predictors of Acute Pain following Motor Vehicle Collision

Citation

Beaudoin, Francesca L.; Gutman, Roee; Zhai, Wanting; Merchant, Roland C.; Clark, Melissa A.; Bollen, Kenneth A.; Hendry, Phyllis L.; Kurz, Michael C.; Lewandowski, Christopher A.; & Pearson, Claire L., et al. (2018). Racial Differences in Presentations and Predictors of Acute Pain following Motor Vehicle Collision. Pain, 159(6), 1056-1063.

Abstract

African-Americans experience a greater burden of acute pain than non-Hispanic white individuals across of variety of acute medical conditions, but it is unknown if this is the case following trauma. We evaluated pain, pain-related characteristics (e.g. peri-traumatic distress), and analgesic treatment in two cohorts of individuals (African-American (n=931) and non-Hispanic white (n=948)) presenting to the emergency department after a motor-vehicle crash (MVC). We performed a propensity-matched analysis (n=796 in each group) to assess racial differences in acute pain in the ED. In multivariable models conducted within the matched sample, race was associated with moderate to severe axial pain (OR 3.2; 95% CI 2.1, 5.0, p<0.001) and higher average NRS scores (1.3; 95% CI: 1.1, 1.6; p=<0.001). After adjustment for pain and other covariates, Non-Hispanic white patients were: more likely to receive an opioid analgesic in the ED (OR 2.0; 95% CI 1.4, 3.0, p<0.001) or at discharge (OR 4.9; 95% CI 3.4, 7.1, p<0.001), and also less likely to receive an NSAID in the ED (OR 0.54; 95% CI 0.38, 0.78; p=0.001) or at discharge (0.31; 95% CI 0.43, 0.84). Racial differences in the severity of acute post-traumatic pain following a motor vehicle collision are not explained by factors such as socio-economic status or crash characteristics. Despite a higher burden of acute pain, African-Americans were less likely to receive opioid analgesics and more likely to receive NSAIDs. Further work is needed to understand the relationship between pain severity, disparities in analgesic treatment and longer-term outcomes, such as post-MVC chronic pain.

URL

http://dx.doi.org/10.1097/j.pain.0000000000001186

Reference Type

Journal Article

Year Published

2018

Journal Title

Pain

Author(s)

Beaudoin, Francesca L.
Gutman, Roee
Zhai, Wanting
Merchant, Roland C.
Clark, Melissa A.
Bollen, Kenneth A.
Hendry, Phyllis L.
Kurz, Michael C.
Lewandowski, Christopher A.
Pearson, Claire L.
O'Neil, Brian J.
Datner, Elizabeth M.
Mitchell, Patricia
Domeier, Robert M.
McLean, Samuel A.