The goal of this study was to test the hypothesis that the cause of racial disparities in pain management of Hispanics versus whites might arise in the assessment of pain. Data were collected from the UCLA Emergency Medicine Center. Subjects included all patients at least 18 years of age who experienced isolated extremity trauma during the period from July 1992 to January 1993.

The study found there was no difference between Hispanics and non-Hispanics in patient assessment of pain, physician assessment of pain, or the discrepancy between the two assessments. (It is noteworthy that, while there were no statistically significant differences, there was a trend toward physicians under estimating the level of pain in Hispanics.) Hispanics received pain medication less often than whites (18.8% versus 23.9%); however, no data were provided with regard to how well pain medication correlated with severity of illness for each ethnic group.

Having an occupational injury, having an injury on an arm versus a leg, and the level of patient pain assessment was significantly correlated with disparity between patient and physician pain assessments. Additionally, physician gender, soft tissue injury versus fracture, and insurance status were slightly predictive of disparity in assessments. This is noteworthy because there were differences between Hispanics and non-Hispanics for some of these variables; differences in insurance status and occupational injury reached statistical significance. However, in multivariate analyses that included these variables, there was no evidence of ethnic group differences in disparity between patient and physician pain assessments.

The authors conclude that the unequal use of analgesics in their original study was not explained by physician inability to assess the pain experience of Hispanics. They did not adopt the possible alternative explanation of straightforward bias by physicians who are less interested in treating pain in Hispanics, "given both the diversity of ethnic representation [on the medical staff] and in [the study] community, and the fact that neither pain assessment nor use of analgesics seems to be related to the ethnicity of the physicians.” They did suggest, however, that physicians might frequently fail to grade pain at all in many patients and might be less likely to grade pain in minority patients. The negative results of this study, then, could be due to not prompting of physicians to assess pain in all patients as part of the study protocol. The authors conclude that prompting pain assessment in physicians might help to correct the disparities in offering pain treatment that were previously reported. Other reasons for this disparity should also be explored.

Letter to the Editor (in response to comment):

“Todd and Hoffman acknowledge that physician ethnicity or cultural background may play an important role in the physician/patient encounter (as noted by Howell). The authors were unable to detect an effect of physician ethnicity based upon inadequate power but suspected that the assimilation process involved in medical training produces physicians that are more alike than not…”