Do racial disparities affect postpartum pain management?

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New research indicates that Hispanic and non-Hispanic black women have higher postpartum pain scores but receive fewer opioids while hospitalized after delivery than their white counterparts. They also are less likely to be given a prescription for the drugs on discharge, suggesting a racial disparity in postpartum pain management.

Methods
The objective of the retrospective cohort study, published in Obstetrics & Gynecology, was to evaluate racial and ethnic differences in women’s postpartum pain scores, inpatient opioid administration and discharge opioid prescriptions in a large and diverse cohort.

The study focused on all deliveries at a single high-volume tertiary care center from December 1, 2015 through November 30, 2016. The participants were women who self-identified as non-Hispanic white, non-Hispanic black, or Hispanic. They were aged 18 years older and had no documented allergies to nonsteroidal anti-inflammatory drugs or morphine.

The authors used medical records to recall three outcomes: 1) patient-reported postpartum pain score (on a scale of 0-10) at discharge; 2) inpatient opioid dosing during postpartum hospitalization (reported as morphine milligram equivalents [MMEs] per day); and 3) receipt of an opioid prescription at discharge. Postpartum pain scores were dichotomized to less than 5 or higher than 5. The associations between each of these outcomes and maternal race/ethnicity were evaluated using multivariable regression models with random effects to account for clustering by the discharge physician.

Findings
A total of 9,900 postpartum women were eligible for the study. The authors found that compared with non-Hispanic white women, Hispanic and non-Hispanic black women had significantly greater odds of reporting a pain score of 5 or higher (adjusted odds ratio [aOR] 1.61, 95% CI 1.26-2.06 and aOR 2.18, 95% CI 1.63-2.91, respectively). However, non-Hispanic black and Hispanic participants received significantly fewer inpatient MMEs/d (adjusted ß -5.03, 95% CI -6.91 to -3.15 and adjusted ß-3.54, 95% CI -5.88 to -1.20, respectively).

Hispanic and non-Hispanic black women were also significantly less likely to receive an opioid prescription at discharge (aOR 0.80, 95% CI 0.67 to -0.96 and aOR 0.78, 95% CI 0.62-0.98) compared with their non-Hispanic white counterparts. The authors noted that no interactions between race/ethnicity and route of delivery were significant, indicating that the observed disparities did not differ according to route of delivery. Propensity score analysis supported the results of the primary analysis. However, the difference in inpatient MMEs/d was not statistically significant.

Conclusions
The authors noted that, contrary their original hypothesis, the study results demonstrated that Hispanic and non-Hispanic black women experience disparities in pain management in the postpartum setting that cannot be explained by less perceived pain. Based on their findings, the authors suggest that more standardized approaches could encourage racial and ethnic equity in pain management.