Pain Clinical Trial
Official title:
Racial and Ethnic Disparities in Acute Pain Control
We aim to compare pain management among three groups of ethnic disparity (ED) patients,
Hispanics, non-Hispanic Blacks, non-Hispanic Whites, and assess whether the observed
association between pain management and race/ethnicity is independent of potentially
important confounding variables (e.g., age, sex, insurance status, education). We also aim
to assess whether the effect of race/ethnicity on adequacy of pain management is explained
by patients' initial pain intensity or by discordance between patient and physician's: a)
race/ethnicity; b) perception of patient's pain. To do this 285 patients with long-bone
fractures will be recruited in the EDs of one municipal and one voluntary hospital serving
an inner-city, disadvantaged population in the Bronx. Data will be collected on pain using
self-reported pain and non-verbal pain expressions at baseline, one hour post-baseline, and
discharge. Data on analgesics administered, patient and physician characteristics will also
be collected.
We plan to conduct a chart review of long bone fractures in 2000 and 2001 so that we can
analyze the association between race/ethnicity and pain management using the same design as
published studies. Comparison of the retrospective and prospective studies will strengthen
inferences that can be drawn.
We hypothesize that Black and Hispanic patients will be less likely to receive opioid
analgesics than white patients.
Status | Completed |
Enrollment | 285 |
Est. completion date | November 2006 |
Est. primary completion date | November 2006 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years to 55 Years |
Eligibility |
Inclusion Criteria: - 18 to 55 years; - Acute pain starting no more than 24 hours before presenting to the ED; - Have isolated long-bone fracture documented on x-ray; - Have a complaint of pain at triage or complaining of pain to the physician; - English and Spanish speaking Exclusion Criteria: - Participating in another clinical study at the same site time of entry; - Unable to complete the pain intensity scale, or complete the questionnaire because of inability to understand the task and questions; - Intoxication with alcohol or other drug; - Pregnancy; - Methadone use; - Use of opioids or tramadol in past seven days; - Patients who are allergic to any analgesics; - Patients with a chronic pain syndrome (sickle cell anemia, fibromyalgia, migraine, peripheral neuropathies) |
Observational Model: Cohort, Time Perspective: Prospective
Country | Name | City | State |
---|---|---|---|
United States | Jacobi Medical Center Emergency Department | Bronx | New York |
United States | Montefiore Medical Center Emergency Department | Bronx | New York |
Lead Sponsor | Collaborator |
---|---|
Agency for Healthcare Research and Quality (AHRQ) |
United States,
Bijur P, Bérard A, Esses D, Calderon Y, Gallagher EJ. Race, ethnicity, and management of pain from long-bone fractures: a prospective study of two academic urban emergency departments. Acad Emerg Med. 2008 Jul;15(7):589-97. doi: 10.1111/j.1553-2712.2008.00149.x. — View Citation
Bijur P, Bérard A, Nestor J, Calderon Y, Davitt M, Gallagher EJ. No racial or ethnic disparity in treatment of long-bone fractures. Am J Emerg Med. 2008 Mar;26(3):270-4. doi: 10.1016/j.ajem.2007.05.010. — View Citation
Bijur PE, Bérard A, Esses D, Nestor J, Schechter C, Gallagher EJ. Lack of influence of patient self-report of pain intensity on administration of opioids for suspected long-bone fractures. J Pain. 2006 Jun;7(6):438-44. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Pain at discharge from Emergency Department | Patients were asked to rate their pain intensity on a validated and reproducible 11-point numerical rating scale (NRS) ranging from 0 "no pain", to 10 "worst imaginable pain" at the time of discharge from the Emergency Department | During Emergency Room visit | No |
Other | Difference in pain from baseline assessment to discharge from Emergency Department | Numerical Rating Scale (NRS) of pain at discharge subtracted from NRS of pain at baseline. | During Emergency Room visit | No |
Primary | Receipt of any analgesics | The names of all medications, dose, route, and time administered were obtained in real time from the chart and ED staff. Patients were categorized as receiving: 1) no analgesics; 2) NSAIDS or acetaminophen; or 3) opioids. If both NSAIDS or acetaminophen and opioids were administered, patients were categorized as having received opioids. Analgesics given solely for fracture reduction were not used to categorize patients. Opioid analgesics were transformed into morphine equivalents as follows: 1 mg morphine = 3 mg of oxycodone; 0.15 mg of hydromorphone, and 13 mg of codeine. No other opioid analgesics were used with the exception of fentanyl, which was only used for fracture reduction. | During Emergency Room visit | No |
Secondary | Receipt of opioid analgesics | Morphine, hydromorphone, oxycodone, codeine | During Emergency Room visit | No |
Secondary | Time to first treatment with analgesic | Time from triage to first analgesic in minutes | During Emergency Room visit | No |
Secondary | Receipt of parenteral analgesics | Analgesic administered parenterally | During Emergency Room visit | No |
Secondary | Initial dose of opioid analgesic mg/kg | Initial dose of opioid analgesic converted to morphine equivalent units as follows: : 1 mg morphine = 3 mg of oxycodone; 0.15 mg of hydromorphone, and 13 mg of codeine. | During Emergency Room visit | No |
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