But providers do
Racial and ethnic minorities have historically received inadequate treatment for acute or chronic pain. Some of this inadequacy is secondary to individual underreporting of pain severity, but oftentimes it’s due to provider bias.
Stated bias may be a result of false stereotypes or flawed beliefs. Sadly, some providers believe that there are biological differences between races in regards to pain management. These beliefs include the incorrect assumption that people of differing color or cultures have thicker skin, higher pain tolerances, or less sensitive nerve endings.
All are untrue and alter the assessment and management of a person’s pain in a negative way. The eventual poor pain management may cause long-term sleep disturbances, depression, anxiety, or the overuse of some medications as compensation.
We define pain as essentially an unpleasant sensory or emotional experience sometimes associated with actual or possible tissue damage—for instance, the excruciating sensations felt during a burn, toothache, or if a bone is broken. Pain can occur immediately after an event, then referred to as acute pain, or persist long after the event when it is known as chronic pain.
Blunting of pain and anxiety after a traumatic event is essential during most surgeries, labor, or diagnostic studies if one is to tolerate the event. Some provider options for blunting include anesthetics, analgesics, and sedatives.
The most invasive technique includes application of general anesthetics. They are inhaled fluorinated hydrocarbon gasses that create loss of sensation and awareness during their administration.
Most general anesthetics are administered in a hospital, clinic, or office setting as anesthetics require the close monitoring of vital functions during their administration. It is essential for patients to share with a provider what medications or compounds they have taken recently as well as any preexisting medical conditions.
The choice of pain relief will be suited to the individual based on their responses in order to maximize safety, but also on the severity and type of pain.
Acute pain relief options
- Sedation or unconsciousness achieved via inhaled gasses or intravenous medications given orally or intravenously. These include hypnotics, sedatives, anxiolytics, or fluorinated hydrocarbons (general anesthetics).
- Regional blocks done with local anesthetics can make the whole arm, leg, or other areas numb (pins and needles sensation). Regional blocks include peripheral nerve blocks of specific nerves such as axillary, femoral, or popliteal blocks to name a few.
- Spinal or epidural blocks are procedures performed with local anesthetics in specific areas of the body.
- Local anesthetic blocks are given at the site of interest via direct injection or application to the site by spraying on or placing the anesthetic directly on the area.
- Oral pain relievers (aka analgesics) include opioids, non-steroidal medications (NSAIDS), and the alternative use of antiseizure or antidepressant medications.
Medications in the above classes (trade name with generic name given):
- Opioids (aka narcotics): Fentanyl, Morphine, Methadone, Dilaudid, Oxycodone
- NSAIDS: Motrin (Ibuprofen), Tylenol (Acetaminophen), Toradol (Ketorolac), Celebrex (Celecoxib)
- Alternatives: Gabapentin (Neurontin), Ketamine (Ketalar)
Chronic pain relief options
- Hot and cold therapy
- Relaxation techniques, yoga, tai chi, breathing exercises
- Medication options: Opioids, Antidepressants, NSAIDS, other classes of medications
- Electrical stimulation
The above in no way includes all the block names or procedures that may be offered, but the list is given to include many commonly used techniques.
Having pain and anxiety treated fully is essential and a right. Many long-term options include coping strategies, which may be used in the setting of acute or chronic pain. At the time of initial encounter with medical services, factors such as gender, age, race, or even insurance status may influence how pain management proceeds.
It is essential that one advocates for adequate pain management. Having knowledge that there are a multitude of options for pain management is useful knowledge for yourself or a family member. Pain is a very complex process and none of the above solutions are perfect, but many can help provide more than adequate relief if done in a timely manner.
Be aware that providers may have biases, cultural beliefs, or stereotypes that may be flawed and impact proper pain management. These biases can impact pain treatment and recommendations. Combine those with underreporting of pain severity by an individual and you have a setup for poor outcomes.
Pain is not a social construct like race or religion. It is a biological consequence felt by all humans. No human need suffer when there are valid options, but many times someone needs to advocate for their offering.
Sean J. Ennevor M.D. graduated with a B.A.S. in biology and economics from Stanford University, and as a Dean’s Scholar from UCLA School of Medicine, where he received his MD. He completed his medical residency and fellowship in anesthesiology at Yale University, where he was chief resident and on staff. He practiced medicine in the Twin Cities for over 14 years and presently serves as an advisor and investor for medical technology companies throughout the country.