Studies have been showing for years that black people are chronically undermedicated for pain. This ties in with a long list of stereotypes and screwy beliefs, including a study from last year that showed that survey participants consistently rate black people as more likely than white people to be capable of holding live coals in their bare hands. Medical providers have been shown to consistently view black patients across the board as less sensitive to pain.
The new study on this shows that this is true even when the patients are four years old.
The researchers examined medical records for almost a million cases of appendicitis in children. Every kid in the study actually had appendicitis, and the study looked specifically at whether they were given pain relief in the ER, and then whether they were given narcotic pain relief or something else, like ibuprofen. It also looked to see how much the kid being in “severe” rather than “moderate” pain affected things, and they controlled for a whole lot of factors, including the sex of the kid, the region, and whether the kid had private insurance, public coverage (such as Medicaid) or if they had no insurance at all.
In the conversations about this study around the Internet, I’ve seen a lot of speculation about the insurance thing. Black kids are more likely to live in poverty than white kids (four times more likely, in fact); is it actually uninsured kids and kids on Medicaid who are being undertreated for pain? The study found that was not the case. Uninsured kids and kids on Medicaid were as likely to likely to get pain medication as the privately insured kids. What they found was racism unmediated by sex discrimination, classism, or regional weirdness. Really, this was just straight up (probably unconscious, but that’s no excuse) racism.
You can read the full study and the JAMA editorial online — both are available free in full text. One interesting thing they found was that as the pain severity increased, the disparity in who got any pain medication decreased — but the non-black kids were far more likely to get narcotic pain medication than the black kids.
I found this whole thing interesting on a personal level because I was a child with appendicitis. When I was 15 years old, my family went to Ohio to spend Thanksgiving with my grandparents, and I woke up the day after Thanksgiving with what I thought was a stomach bug. I felt steadily worse all day. Around 10 p.m. Friday night, I reported to my mother that I was having rebound pain. (When you have appendicitis, it hurts when you press on your stomach, but then it hurts again when you let go. I was the sort of kid who read books intended for parents, so I knew this was a classic appendicitis symptom.) My mother took me to the ER.
I was not, in fact, given any pain medication that night. At the time, doctors didn’t want to medicate you for suspected appendicitis because they thought it might cover up the symptoms and make it harder to properly diagnose. (This was debunked in 2005.) I only ever had moderate pain from the appendicitis, though — the most traumatic piece of the experience was a totally inept IV insertion. I was admitted overnight, then had surgery the next morning.
I was in quite a lot of pain when I woke up from the anesthesia, and was given shots of something that I assume was a narcotic. But the following day, I was feeling quite a bit better, and when the nurse came around to give me another shot of pain medication, I refused it.
She sighed deeply, put down the syringe, and looked me in the eye. “A lot of teenagers are like you,” she said. “Some teenagers are afraid they’re going to get addicted, so first off, you are not going to get addicted. I promise that’s not something you need to worry about. Other teenagers are trying to tough it out. I believe that you’re tough. But right now, your body can do one of two things. It can cope with pain, or it can heal. I really think you should pick healing.” I let her give me the shot.
One of the suggestions made in the JAMA editorial is that pain medication should be routinely offered to all kids in the ER with suspected appendicitis. However, it’s worth noting that some kids will refuse pain medication for the same reasons I did — fear of addiction fostered by their in-school drug education programs, with a side of “I’m tough and don’t really need it.” Those kids should get the same gentle pressure I got, or this problem is not going to be solved.
[Post image via Shutterstock]