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Papers of the Week

Papers: 27 Jul 2019 - 2 Aug 2019


Human Studies

2020 Jan - Feb

J Pain



Assessment and treatment recommendations for pediatric pain: the influence of patient race, patient gender, and provider pain-related attitudes.


Miller MM, Williams AE, Zapolski TCB, Rand KL, Hirsh AT
J Pain. 2020 Jan - Feb; 21(1-2):225-237.
PMID: 31362065.


Previous studies have documented that racial minorities and women receive poorer pain care than their demographic counterparts. Providers contribute to these disparities when their pain-related decision-making systematically varies across patient groups. Less is known about racial and gender disparities in children with pain or the extent to which providers contribute to these disparities. In a sample of 129 medical students (henceforth referred to as 'providers'), Virtual Human methodology and a pain-related version of the Implicit Association Test (IAT) were used to examine the effects of patient race/gender on providers' pain assessment/treatment decisions for pediatric chronic abdominal pain, as well as the moderating role of provider implicit pain-related race/gender attitudes. Findings indicated that providers rated Black patients as more distressed (mean difference [MD]=2.33, p<.01, SE=.71, 95% CI=.92, 3.73) and as experiencing more pain-related interference (MD=3.14, p<.01, SE=.76, 95% CI=1.63, 4.64) compared to White patients. Providers were more likely to recommend opioids for Black patients than White patients (MD=2.41, p<.01, SE=.58, 95% CI=1.05, 3.76). Female patients were perceived to be more distressed by their pain (MD=2.14, p<.01, SE=.79, 95% CI=.58, 3.70) than male patients, however there were no gender differences in treatment recommendations. IAT results indicated that providers held implicit attitudes that Black Americans (M=.19, SD=.29) and males (M=.38, SD=.29) were more pain-tolerant than their demographic counterparts; however, these implicit attitudes did not significantly moderate their pain assessment/treatment decisions. Future studies are needed to elucidate specific paths through which the pain experience and care of children differ across racial and gender groups. PERSPECTIVE: Providers' pain assessment (i.e., pain distress/pain interference) and treatment (i.e., opioids) of pediatric pain differs across patient race and to a lesser extent, patient gender. This study represents a critical step in research on pain-related disparities in pediatric pain.