Gender, age and ethnic aspects of analgesia in acute abdominal pain: is analgesia even across the groups?

Banz, Vanessa; Christen, Brigitte; Paul, Kathrin; Martinolli, Luca; Candinas, Daniel; Zimmermann, Heinz; Exadaktylos, Aristomenis K.

doi:10.1111/j.1445-5994.2010.02255.x

Cited by 13 publications

(9 citation statements)

References 37 publications

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“…Sex differences in the analgesic effects of mu-opioid agonists has been documented extensively in animal and, to a lesser extent, in human studies (16). Female showed a much more reduction in pain score during 30- 45 minutes follow up that may contribute to different pain perception in different genders and also the role of opioid receptors characteristics in female due to hormonal effects (15, 17-21). Cepeda found that women had more intense pain and required 30% more morphine to achieve a similar degree of analgesia compared with men (22).…”

Section: Discussionmentioning

confidence: 98%

Time of Admission, Gender and Age: Challenging Factors in Emergency Renal Colic - A Preliminary Study

Behzadnia¹,

Javadzadeh²,

Saboori³

2012

Trauma Mon

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BackgroundNephrolithiasis is a relatively common problem and a frequent Emergency Department (ED) diagnosis in patients who present with acute flank/abdominal pain. The pain management in these patients is often challenging.ObjectivesTo investigate the most effective dose of morphine with the least side effects in emergency renal colic patients.Materials and Methods150 renal colic patients who experienced a pain level of 4 or greater, based on visual analog scale (VAS) at admission time were included. Pain was scored on a 100 mm VAS (0 = no pain, 100 = the worst pain imagined). When patients arrived at ED, a physician would examine the patients and assessed initial pain score, then filled a questionnaire according to the patient information. Patients were assigned to receive 2.5 mg morphine sulfate intravenously. We monitored patients’ visual analog scale (VAS), and adverse events at different time points (every 15 minutes) for 90 minutes. Additional doses of intravenous morphine (2.5 mg) were administered if the patient still had pain. (Max dose: 10 mg). The cumulative dose of morphine, defined as the total amount of morphine prescribed to each patient during the 90 minutes of the study, was recorded. Patients were not permitted to use any nonsteroidal anti-inflammatory drugs as coadjuvant analgesics during the study period. Subjects with inadequate pain relief at 90 minutes received rescue morphine and were excluded from the study. The primary end point in this study was pain relief at 90 minutes, defined as either VAS<40 or decrease of 50% or more as compared to the initial VAS. The secondary objective was to detect the occurrence of adverse effects at any time points in ED.ResultsThe studied patients consisted of 104 men and 46 women with the mean age of 43 ±14 years (range, 18 to 75 years). There was no statistically significant difference between the mean age and gender differences in pain response. Rescue analgesia at 30 minutes were given in 54.5% receiving morphine. The average time to painless was 35 minutes. But there were no statistically significant differences between the mean age and gender differences in pain response (P > 0.05). Older patients responded sooner to morphine than the young. Most of the patients had a pain score of 90 -100 (77.3 %) at the beginning that was reduced to 29.4% during the 30 minutes follow up. During the first hour, we found that 94.7% of the patients had no pain or significant pain reduction and only 2.1% of the patients still had pain.ConclusionsWe conclude that there were no significant differences among the gender, time of admission and side - effects in renal colic patients in response to morphine.

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Section: Discussionmentioning

confidence: 98%

Time of Admission, Gender and Age: Challenging Factors in Emergency Renal Colic - A Preliminary Study

Behzadnia¹,

Javadzadeh²,

Saboori³

2012

Trauma Mon

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“…Banz et al found no difference in the overall likelihood of analgesic reception in a cohort of women arriving to the ED with any type of pain. 18 However, our study is novel in that it examines the first 90 minutes of the ED visit, when disparities do exist, before becoming non-significant as the ED visit progresses. This difference in early analgesic administration can likely be explained by the longer delays in analgesic administration to women found by this study.…”

Section: Discussionmentioning

confidence: 99%

A Multicenter Evaluation of the Impact of Sex on Abdominal and Fracture Pain Care

et al. 2015

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Background Previous studies examining gender-based disparities in Emergency Department (ED) pain-care have been limited to a single pain-condition, a single study-site, and lack rigorous control for confounders. Objective A multicenter evaluation of the effect of gender on abdominal pain (AP) and fracture (FP) pain-care outcomes. Research Design Retrospective cohort-review of ED visits at 5 US hospitals in January, April, July and October 2009. Subjects 6,931 patients with a final ED diagnosis of FP (n=1682) or AP (n=5249). Measures The primary-predictor was gender. The primary outcome was time to analgesic-administration. Secondary outcomes included time to medication-order, and the likelihood the receiving an analgesic and change in pain scores 360 minutes after triage: Multivariable models, clustered by study site, were conducted to adjust for race, age, comorbidities, initial pain-score, ED crowding and triage acuity. Results On adjusted analyses, compared with men, women with AP waited longer for analgesic administration [AP Women: 112 (65–187) min, Men: 96 (52–167) min, p<0.001] and ordering Women: [84 (41–160) min, Men: 71 (32–137) min, p<0.001], whereas women with FP did not (Administration: p=0.360; Order: p=0.133). Compared with men, women with AP were less likely to receive analgesics in the first 90 minutes (OR: 0.766, 95% CI: 0.670 – 0.875, p<0.001), whereas women with FP were not (p=0.357). Discussion In this multicenter study, we found that women experienced delays in analgesic administration for AP, but not for FP. Future research and interventions to decrease gender-disparities in pain-care should take type of pain into account.

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“…Although pain is prevalent in the emergency department (ED), it is underreported and undertreated [1][2][3]. Previous studies have found that oligoanalgesia is common in the ED, caused by both delays to analgesic administration and under administration of analgesic doses [4,5].…”

Section: Introductionmentioning

confidence: 99%

A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures

et al. 2016

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Objectives. To identify differences in emergency department (ED) pain-care based on the type of fracture sustained and to examine whether fracture type may influence the more aggressive analgesic use previously demonstrated in older patients.Design. Secondary analysis of retrospective cohort study. Measurements. Primary-predictor was type of fracture (LBF vs. SBF). Pain-care process outcomes included likelihood of analgesic administration, opioid-dose, and time to first analgesic. General estimating equations were used to control for age, gender, race, baseline pain score, triage acuity, comorbidities and ED crowding. Subgroup analyses were conducted to analyze age-based differences in pain care by fracture type.Results. A larger proportion of patients with LBF (30%) were older (>65 years old) compared to SBF (13%). Compared with SBF, patients with LBF were associated with greater likelihood of analgesic-administration (OR 5 2.03; 95 CI 5 1.58 to 2.62; P < 0.001) and higher opioid-doses (parameter estimate 5 0.268; 95 CI 5 0.239 to 0.297; P < 0.001). When LBF were examined separately, older-patients had a trend to longer analgesic wait-times (99 [55-163] vs. 76 [35-149] minutes, P 5 0.057), but no other differences in process outcomes were found.Conclusion. Long bone fractures were associated with more aggressive pain care than SBF. When fracture types were examined separately, older patients did not appear to receive more aggressive pain care. This difference should be accounted for in further research.

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Gender, age and ethnic aspects of analgesia in acute abdominal pain: is analgesia even across the groups?

Cited by 13 publications

References 37 publications

Time of Admission, Gender and Age: Challenging Factors in Emergency Renal Colic - A Preliminary Study

Time of Admission, Gender and Age: Challenging Factors in Emergency Renal Colic - A Preliminary Study

A Multicenter Evaluation of the Impact of Sex on Abdominal and Fracture Pain Care

A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures

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