Abstract ID: A17
Abstract Title: Ethnocultural Bias in the Invasive Management of Radicular Pain
Authors: Nampiaparampil D1, Harden R2
Spaulding Rehabilitation Hospital/ Harvard Medical School Boston MA USA1, Rehabilitation Institute of Chicago/ Northwestern University Feinberg School of Medicine Chicago IL 2
Poster Type: Either
ABSTRACT BODY
Introduction: Chronic pain management is a clinical problem that extends across the spectrum of medical and surgical specialties. The objective of this study was to test the hypothesis that physicians may prescribe strategies for pain management at different rates to different racial or socioeconomic groups.
Materials and Methods: Design: Randomized controlled study. Setting: Tertiary care urban academic hospital, free-standing urban rehabilitation hospital, and academically affiliated suburban community hospitals. Participants: 54 attending, fellow, and resident physicians. Interventions: Physicians were given 1 of 2 scenarios of a patient with chronic low back and lower extremity pain. In one version, the patient is a Caucasian male with Blue Cross Health Insurance. In the other version, the patient is an African-American male with Medicaid. All other aspects of the survey scenarios are identical. The physicians were subsequently presented with questionnaires about their treatment plans. Main Outcome Measure: Subjects’ survey responses.
Results: Results: Of the 54 physicians who received the survey, 53 completed it (response rate, 98.1%). There were 27 Caucasian patient surveys and 26 African-American patient surveys. We split the 53 physicians’ responses into 2 groups of low likelihood (32 responses) vs. high likelihood (21 responses) of considering any form of nerve block. Of the patients who were less likely to be considered for a nerve block, 20/32 (62.5%) were African American. Of the patients more likely to be considered for a nerve block, only 6/21 (28.6%) were African-American. Patient race and socioeconomic status significantly affected the rate of consideration for a nerve block (P=.02). We also split the physicians’ responses into 2 groups of low likelihood (37 responses) vs. high likelihood (16 responses) to be considered for surgery. Of the patients who were less likely to be considered for surgery, 21/37 (56.8%) were African-American. Of the patients more likely to be considered surgery, 5/16 (31.3%) were African-American. Patient race and socioeconomic status trended towards affecting the rate of surgical consideration (p=.09). Finally, the physicians’ responses were split into 2 groups of low likelihood (27 responses) vs. high likelihood (26 responses) to be prescribed an exercise program. Of the patients less likely to be prescribed an exercise program, 10/27 (37.0%) were African-American and of the patients more likely to be prescribed an exercise program, 16/26 (61.5%) were African-American. Patient race and socioeconomic status trended towards affecting the prescription of exercise (p=.07).
Discussion: This study suggests that patient race and socioeconomic status influence physicians’ decisions about use of different methods of pain management. African-American patients may be less likely to be considered for invasive therapy such as spinal injections for chronic low back and lower extremity pain. To our knowledge, this pilot study is the first to explore this possibility.
ATTACHED FILES
Reg Anesth Pain Med 2005; 30(3):A17