Racial differences in the treatment of acute pain unrelated to treatment preference

Efforts to standardize opioid prescribing have shown that black patients are less likely to receive opioid acute pain medication treated in the emergency room (ED).

Despite racial differences in pain management, questions remain about the factors associated with the differences, with some experts theorizing the statistical discrimination in which clinicians make decisions based on generalizations about a group rather than a patient.

Investigators, led by Zachary F. Meisel, MD, MPH, Perelman School of Medicine, University of Pennsylvania, observed that differences in acute pain management in black patients compared to white patients persisted after clinicians provided additional patient-level data suggesting that a lack of patient information is not linked to inequalities in prescribing opioids.

To learn

The study addressed gaps in pain management through an examination of racial differences in prescribing opioids through a secondary analysis of data from the randomized clinical trial Life Stories for Opioid Risk Reduction in the ED (Life STORRIED).

The patients were enrolled between June 2017 and August 2019.

The team found that the inclusion criteria impaired presentation to the emergency room for uncomplicated ureteral colic or back and / or neck pain of the musculoskeletal system between the ages of 18 and 70 and the clinician’s intention to discharge patients ≥ 24 hours after admission to the clinic .

After randomization, patients were asked to complete a series of surveys, including a demographic survey, a pain management preference survey, and the Opioid Risk Tool (ORT) to assess the risk of opioid abuse.

ORT has a score range of 0-26, with 0-3 indicating low risk, 4-7 indicating moderate risk and ≥ 8 indicating high risk.

Investigators assessed the risk of opioid abuse using the ORT and collected patient demographics through a survey conducted during the emergency room.

Key findings included that the patient received an opioid prescription upon discharge from the emergency room and the patient’s preference for opioid-containing treatment was consistent with the treatment received.

They defined concordant treatment when a participant who preferred opioids received a prescription on discharge or when a patient who preferred no opioid received no prescription on discharge.


A total of 1302 participants were enrolled in the Life STORRIED clinical study, with a total of 1012 patients having complete data on demographics and treatment preferences in the secondary analysis.

Of the total of 671 patients (66.3%) were assigned to the treatment arm, while 341 patients (33.7%) were assigned to the control arm.

Demographics showed 563 patients (55.6%) who identified themselves as female, with a mean age of 40.8 years. In addition, a total of 455 patients (45.0%) identified as white, while 384 patients (37.9%) identified as black.

The data shows that 377 patients (37.3%) preferred opioids upon discharge from the emergency room, 238 patients (23.6%) received a prescription for opioids upon discharge from the emergency room, and 659 patients (65.2%) received treatment consistent with preference.

Investigators observed that white patients were more likely to be prescribed opioids on discharge from the emergency room than black patients (33.7% versus 12.2%, P <0.001).

In addition, when demographic and clinical characteristics were checked, black patients had lower chances of receiving opioid medication upon discharge from the emergency room compared to white patients (OR 0.42; 95% CI 0.27-0.65) .

When looking at patients who preferred and did not prefer opioids, the team found that black patients still had lower chances of being discharged with a prescription of opioids compared to white patients.

The data show this in those who preferred opioids (OR, 0.43; 95% CI, 0.24-0.77) and in those who preferred no opioids (OR, 0.45; 95% CI , 0.23-0.89).


“These differences were not addressed by assessing patient treatment preferences and the risk of opioid abuse and communicating them to clinicians,” the investigators wrote. “Future research is warranted to further explore alternative factors related to prescribing differences.

The study “Patient Preference and Risk Assessment in Opioid Prescribing Disparities A Secondary Analysis of a Randomized Clinical Trial” was published online in the JAMA Network Open.