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Published in: European Journal of Trauma and Emergency Surgery 3/2015

01-06-2015 | Original Article

Gender, age and ethnicity influence on pain levels and analgesic use in the acute whiplash injury

Authors: L. Koren, E. Peled, R. Trogan, D. Norman, Y. Berkovich, S. Israelit

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2015

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Abstract

Purpose

Initial pain level in the acute whiplash injury is the most consistent predictor of transformation to a chronic pain syndrome. The risk factors for those early pain levels were, to our knowledge, scarcely evaluate to this date. We set to evaluate whether gender, age or ethnicity comprise a risk factor for those initial pain levels. Further, gender, age and ethnicity have been shown to be bias factors in pain management. We investigated if gender, age or ethnicity are  bias factor in pain management in the face of a standardized pain treatment protocol in the acute whiplash injury.

Methods

We reviewed 2,538 patients with acute whiplash injury that were treated at our emergency department (ED). Gender, age and ethnicity were investigated as risk factors for elevated visual analog scale (VAS) scores. Those factors were also investigated as bias in pain medication administration in the face of a standardized analgesic protocol.

Results

Women had significantly higher VAS scores (p = 0.009). Age and ethnicity did not influence pain levels. There was no influence of gender or age on pain medication administration. The Jewish patients (the majority in Israel) were administered fewer pain medication (p < 0.0001).

Conclusion

Women have higher initial pain levels in the acute whiplash injury. Age and ethnicity have less impact on those pain levels. A pain management protocol might reduce bias in pain management in the acute whiplash injury in the ED. The Jewish population tends to be less receptive to pain medication administration.
Literature
1.
go back to reference Quinlan KP, Annest JL, Myers B, et al. Neck strains and sprains among motor vehicle occupants—United States, 2000. Accid Anal Prev. 2004;36(1):21–7.PubMedCrossRef Quinlan KP, Annest JL, Myers B, et al. Neck strains and sprains among motor vehicle occupants—United States, 2000. Accid Anal Prev. 2004;36(1):21–7.PubMedCrossRef
2.
go back to reference Spitzer W, Skovron M, Salmi L, et al. Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining “whiplash” and its management. Spine. 1995;15:1S–73S. Spitzer W, Skovron M, Salmi L, et al. Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining “whiplash” and its management. Spine. 1995;15:1S–73S.
3.
go back to reference Lamb SE, Williams MA, Withers E, et al. A national survey of clinical practice for the management of whiplash-associated disorders in UK emergency departments. Emerg Med J. 2009;26(9):644–7.PubMedCrossRef Lamb SE, Williams MA, Withers E, et al. A national survey of clinical practice for the management of whiplash-associated disorders in UK emergency departments. Emerg Med J. 2009;26(9):644–7.PubMedCrossRef
4.
go back to reference Berglund A, Bodin L, Jensen I, et al. The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury. Pain. 2006;125(3):244–56.PubMedCrossRef Berglund A, Bodin L, Jensen I, et al. The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury. Pain. 2006;125(3):244–56.PubMedCrossRef
5.
go back to reference Kjettrup-Jensen M, Sjogren P, Ekholm O, et al. Identifying a long-term/chronic, non-cancer pain population using a one-dimensional verbal pain rating scale: an epidemiological study. Eur J Pain. 2004;8:145–52.CrossRef Kjettrup-Jensen M, Sjogren P, Ekholm O, et al. Identifying a long-term/chronic, non-cancer pain population using a one-dimensional verbal pain rating scale: an epidemiological study. Eur J Pain. 2004;8:145–52.CrossRef
6.
go back to reference Unruh A, Rithie J, Merskey H. Does gender affect appraisal of pain and pain coping strategies. Clin J Pain. 1999;15:31–40.PubMedCrossRef Unruh A, Rithie J, Merskey H. Does gender affect appraisal of pain and pain coping strategies. Clin J Pain. 1999;15:31–40.PubMedCrossRef
7.
go back to reference Li SF, Greenwald PW, Gennis P, et al. Effect of age on acute pain perception of a standardized stimulus in the emergency department. Ann Emerg Med. 2001;38:644–7.PubMedCrossRef Li SF, Greenwald PW, Gennis P, et al. Effect of age on acute pain perception of a standardized stimulus in the emergency department. Ann Emerg Med. 2001;38:644–7.PubMedCrossRef
8.
go back to reference Bijur P, Bérard A, Esses D, et al. Race, ethnicity, and management of pain from long bone fractures: a prospective study of two academic urban emergency departments. Acad Emerg Med. 2008;15(7):589–97.PubMedCrossRef Bijur P, Bérard A, Esses D, et al. Race, ethnicity, and management of pain from long bone fractures: a prospective study of two academic urban emergency departments. Acad Emerg Med. 2008;15(7):589–97.PubMedCrossRef
9.
go back to reference Holm LW, Carroll LJ, Cassidy JD, et al. Factors influencing neck pain intensity in whiplash-associated disorders. Spine. 2006;31:E98–104.PubMedCrossRef Holm LW, Carroll LJ, Cassidy JD, et al. Factors influencing neck pain intensity in whiplash-associated disorders. Spine. 2006;31:E98–104.PubMedCrossRef
10.
go back to reference Walton DM, Macdermid JC, Giorgianni AA, Mascarenhas JC, West SC, Zammit CA. Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013;43(2):31–43.PubMedCrossRef Walton DM, Macdermid JC, Giorgianni AA, Mascarenhas JC, West SC, Zammit CA. Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013;43(2):31–43.PubMedCrossRef
11.
go back to reference Motov SM, Khan AN. Problems and barriers of pain management in the emergency department: are we ever going to get better? J Pain Res. 2009;2:5.PubMedCentral Motov SM, Khan AN. Problems and barriers of pain management in the emergency department: are we ever going to get better? J Pain Res. 2009;2:5.PubMedCentral
12.
go back to reference Yanuka M, Soffer D, Halpern P. An interventional study to improve the quality of analgesia in the emergency department. CJEM. 2008;10:435–9.PubMed Yanuka M, Soffer D, Halpern P. An interventional study to improve the quality of analgesia in the emergency department. CJEM. 2008;10:435–9.PubMed
13.
go back to reference Bring G, Björnstig U, Westman G. Gender patterns in minor head and neck injuries: an analysis of casualty register data. Accid Anal Prev. 1996;28(3):359–69.PubMedCrossRef Bring G, Björnstig U, Westman G. Gender patterns in minor head and neck injuries: an analysis of casualty register data. Accid Anal Prev. 1996;28(3):359–69.PubMedCrossRef
14.
go back to reference Fillingim RB, King CD, Ribeiro-Dasilva MC, et al. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009;10(5):447–85.PubMedCentralPubMedCrossRef Fillingim RB, King CD, Ribeiro-Dasilva MC, et al. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009;10(5):447–85.PubMedCentralPubMedCrossRef
15.
go back to reference Gagliese L, Katz J. Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients. Pain. 2003;103(1):11–20.PubMedCrossRef Gagliese L, Katz J. Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients. Pain. 2003;103(1):11–20.PubMedCrossRef
16.
go back to reference Bernabei R, Gambassi G, Lapane K, et al. Management of pain in elderly patients with cancer. SAGE study group. Systematic assessment geriatric drug use via epidemiology. JAMA. 1998;279:1877–82.PubMedCrossRef Bernabei R, Gambassi G, Lapane K, et al. Management of pain in elderly patients with cancer. SAGE study group. Systematic assessment geriatric drug use via epidemiology. JAMA. 1998;279:1877–82.PubMedCrossRef
17.
go back to reference Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003;4(3):277–94.PubMedCrossRef Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003;4(3):277–94.PubMedCrossRef
18.
go back to reference Lavin R, Park J. A characterization of pain in racially and ethnically diverse older adults: a review of the literature. J Appl Gerontol. 2014;33(3):258–90.PubMedCrossRef Lavin R, Park J. A characterization of pain in racially and ethnically diverse older adults: a review of the literature. J Appl Gerontol. 2014;33(3):258–90.PubMedCrossRef
19.
go back to reference Todd KH, Lee T, Hoffman JR. The effect of ethnicity on physician estimates of pain severity in patients with isolated extremity trauma. JAMA. 1994;271:925–8.PubMedCrossRef Todd KH, Lee T, Hoffman JR. The effect of ethnicity on physician estimates of pain severity in patients with isolated extremity trauma. JAMA. 1994;271:925–8.PubMedCrossRef
20.
go back to reference Widmalm S, Gunn S, Christiansen R, et al. Association between CMD signs and symptoms, oral para functions, race and sex, in 4–6-year-old African-American and Caucasian children. J Oral Rehabil. 1995;22:95–100.PubMedCrossRef Widmalm S, Gunn S, Christiansen R, et al. Association between CMD signs and symptoms, oral para functions, race and sex, in 4–6-year-old African-American and Caucasian children. J Oral Rehabil. 1995;22:95–100.PubMedCrossRef
21.
go back to reference Plesh O, Crawford PB, Gansky SA. Chronic pain in a biracial population of young women. Pain. 2002;99:515–23.PubMedCrossRef Plesh O, Crawford PB, Gansky SA. Chronic pain in a biracial population of young women. Pain. 2002;99:515–23.PubMedCrossRef
22.
go back to reference Jimenez N, Dansie E, Buchwald D, Goldberg J. Pain among older hispanics in the United States: is acculturation associated with pain? Pain Med. 2013;14(8):1134–9.PubMedCentralPubMedCrossRef Jimenez N, Dansie E, Buchwald D, Goldberg J. Pain among older hispanics in the United States: is acculturation associated with pain? Pain Med. 2013;14(8):1134–9.PubMedCentralPubMedCrossRef
25.
go back to reference Safdar B, Choiniere M, Crandall C, et al. Impact of patient gender on pain management practices in the emergency department: a multicenter study. Ann Emerg Med. 2006;48:S12. Safdar B, Choiniere M, Crandall C, et al. Impact of patient gender on pain management practices in the emergency department: a multicenter study. Ann Emerg Med. 2006;48:S12.
26.
go back to reference Chen EH, Shofer FS, Dean AJ, et al. Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Acad Emerg Med. 2008;15:414–8.PubMedCrossRef Chen EH, Shofer FS, Dean AJ, et al. Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Acad Emerg Med. 2008;15:414–8.PubMedCrossRef
27.
go back to reference Brown JC, Klein EJ, Lewis CW, et al. Emergency department analgesia for fracture pain. Ann Emerg Med. 2003;42(2):197.PubMedCrossRef Brown JC, Klein EJ, Lewis CW, et al. Emergency department analgesia for fracture pain. Ann Emerg Med. 2003;42(2):197.PubMedCrossRef
28.
go back to reference Quazi S, Eberhart M, Jacoby J, et al. Are racial disparities in ED analgesia improving? Evidence from a national database. Am J Emerg Med. 2008;26(4):462–4.PubMedCrossRef Quazi S, Eberhart M, Jacoby J, et al. Are racial disparities in ED analgesia improving? Evidence from a national database. Am J Emerg Med. 2008;26(4):462–4.PubMedCrossRef
29.
go back to reference Oldenmenger WH, Sillevis Smitt PA, van Dooren S, et al. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer. 2009;45(8):1370–80.PubMedCrossRef Oldenmenger WH, Sillevis Smitt PA, van Dooren S, et al. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer. 2009;45(8):1370–80.PubMedCrossRef
Metadata
Title
Gender, age and ethnicity influence on pain levels and analgesic use in the acute whiplash injury
Authors
L. Koren
E. Peled
R. Trogan
D. Norman
Y. Berkovich
S. Israelit
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2015
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-014-0419-2

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