Background & Aims
In nonobstetric populations, studies have demonstrated racial and ethnic disparities in the experience, assessment, and treatment of pain [5]. While research has also shown that racial/ethnic disparities in obstetrical care and outcomes exist, less work has focused on perinatal pain and opioid consumption [1,4,7]. Further, some studies have found that Black American women are more likely to undergo cesarean delivery compared to other racial groups [2,3]. As cesarean delivery is one of the most common surgical procedures and is associated with heightened levels of psychological distress [6], it is important to investigate disparities in the experience and treatment of perinatal pain. The present study investigated racial/ethnic differences in preoperative clinical pain and psychological factors, as well as postoperative pain and inpatient opioid consumption during the first 48 hours following cesarean delivery.
Methods
In this prospective, observational study, 641 women scheduled for cesarean delivery at a large academic medical center in Boston, MA, USA completed validated clinical pain (Brief Pain Inventory) and psychological (Patient-Reported Outcomes Measurement Information System; Pain Catastrophizing Scale) questionnaires before cesarean delivery. Over the first 48 hours after surgery, nurses assessed patients’ pain (0-10) on a routine schedule, approximately every 4 hours, and oral oxycodone, oral hydromorphone, or IV hydromorphone were prescribed as needed and administered upon patient request. Patients’ average and maximum pain scores and average opioid consumption (MMEs) over the first postoperative 48 hours were extracted from electronic medical records. Analyses of Variance (ANOVAs) were conducted to examine racial/ethnic differences in baseline clinical pain, psychological factors, and postoperative pain and opioid consumption.
Results
Patients had a mean age of 34 years (SD=4), a mean gestational age of 38.7 weeks, and 34% were undergoing primary cesarean delivery. Patients identified as White (73.6%), African American (10.5%), Hispanic/Latina (10%), and Asian (5.9%). Prior to surgery, African American and Hispanic/Latina women reported greater pain severity than White and Asian women (ps<.05), and thus, baseline pain was included as a covariate in subsequent analyses. There were no significant racial/ethnic differences in preoperative anxiety, depression, or pain catastrophizing (ps>.05). Over the first 48 hours after surgery, African American and Hispanic/Latina women received greater MMEs than White and Asian women (ps<.05). Interestingly, despite receiving greater MMEs, African American and Hispanic/Latina women still reported higher levels of postoperative pain than White and Asian women (ps<.05). There was not a significant racial/ethnic difference in the number of postoperative pain scores collected (p>.05).
Conclusions
We found that African American and Hispanic/Latina women reported significantly higher pain both preoperatively and postoperatively compared to White and Asian women, despite receiving more inpatient opioids. While several biopsychosocial factors have been shown to modulate the pain experience, we did not observe racial/ethnic differences in preoperative psychological characteristics in the present sample. Future studies should examine the roles of other factors, such as cultural differences in pain treatment preferences, pain expectations, discrimination, and trauma, which may contribute to observed differences in pain.
References
1. Badreldin N, Grobman WA, Yee LM. Racial Disparities in Postpartum Pain Management. Obstet Gynecol. 2019;134(6):1147-1153. doi:10.1097/AOG.0000000000003561
2. Braveman P, Egerter S, Edmonston F, Verdon M. Racial/ethnic differences in the likelihood of cesarean delivery, California. Am J Public Health. 1995;85(5):625-630. doi:10.2105/ajph.85.5.625
3. Bryant AS, Washington S, Kuppermann M, Cheng YW, Caughey AB. Quality and equality in obstetric care: racial and ethnic differences in caesarean section delivery rates. Paediatr Perinat Epidemiol. 2009;23(5):454-462. doi:10.1111/j.1365-3016.2009.01059.x
4. Johnson, J. D., Asiodu, I. V., McKenzie, C. P., Tucker, C., Tully, K. P., Bryant, K., … & Stuebe, A. M. (2019). Racial and ethnic inequities in postpartum pain evaluation and management. Obstetrics & Gynecology, 134(6), 1155-1162.
5. Meints SM, Cortes A, Morais CA, Edwards RR. Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Manag. 2019;9(3):317-334. doi:10.2217/pmt-2018-0030
6. Olieman RM, Siemonsma F, Bartens MA, Garthus-Niegel S, Scheele F, Honig A. The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review. BMC Pregnancy Childbirth. 2017;17(1):195. doi:10.1186/s12884-017-1371-z
7. Poehlmann, J. R., Avery, G., Antony, K. M., Broman, A. T., Godecker, A., & Green, T. L. (2022). Racial disparities in post-operative pain experience and treatment following cesarean birth. The Journal of Maternal-Fetal & Neonatal Medicine, 35(26), 10305-10313.
Presenting Author
Jenna Wilson
Poster Authors
Jenna Wilson, PhD
PhD
Brigham and Women's Hospital; Harvard Medical School
Lead Author
Emily Rosado
MA
Brigham and Women's Hospital
Lead Author
Jingui He
RD
Brigham and Women's Hospital
Lead Author
SAMANTHA MEINTS
PhD
Dept. of Anesthesiology, Perioperative & Pain Medicine, Brigham & Women’s Hospital, Boston, MA, USA
Lead Author
Mieke Soens
PhD
Lead Author
Kristin Schreiber
Brigham and Women's Hospital
Lead Author
Topics
- Racial/Ethnic/Economic Differences/Disparities