title: Pain outcomes of inpatient pain and palliative care consultations: differences by race and diagnosis.
abstract: BACKGROUND
  Pain management disparities exist among patients not receiving palliative care. We examined pain outcomes for disparities among patients receiving palliative care.
  
  
  METHODS
  At a 542-bed teaching hospital in Honolulu, The Queens' Medical Center Pain and Palliative Care Department collected patient characteristics and pain severity (initial, final) for each consultation from 2005 through 2009. Analyses compared pain levels by race (white, Asian, Hawaiian/Pacific Islander [PI], other) and consultation diagnosis (cancer, noncancer medical, surgical [59% orthopedic], other). Multiple regression models analyzed factors associated with lower final pain levels and pain reduction.
  
  
  RESULTS
  Study population included 4658 patients. No final pain was reported by more non-white patients (33%-39%) than white (27%, p<0.0001) and more cancer and noncancer medical patients (45%-54%) than surgical/other patients (20%-31%, p<0.0001). Asian (adjusted odds ratio [aOR] 1.24; 95% confidence interval [CI] 1.06-1.46; p=0.007) and PI (aOR 1.46, 95% CI 1.20-1.77, p=0.0001) races had increased likelihoods of lower final pain severity versus whites, controlling for age, gender, Karnofsky score, preconsult length of stay, and initial pain severity. Surgical diagnoses had decreased likelihood of lower final pain levels versus cancer (aOR 0.38, 95% CI 0.32-0.46, p<0.0001). Among 2304 patients reporting moderate/severe initial pain, 1738 (75.4%) reported pain reduction to mild/no final pain. PI race was associated with pain reduction versus whites (aOR 1.57, 95% CI 1.17-2.10, p=0.003). Surgical diagnoses had decreased likelihood of pain reduction vs. cancer (aOR 0.52, 95% CI 0.39-0.71, p<0.0001).
  
  
  CONCLUSIONS
  Pain outcomes were similar or better among non-white races than whites. Surgical patients reported more final pain than cancer patients.
authors: Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA. bellcl@hawaii.edu
authors: Christina L
authors: CL
authors: Bell
authors: Meiko
authors: M
authors: Kuriya
authors: Daniel
authors: D
authors: Fischberg
mesh_terms: D000368:Aged; D003142:Communication; D016001:Confidence Intervals; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology; D016017:Odds Ratio; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care / Q000379:methods*; D010817:Physician-Patient Relations; D044469:Racial Groups; D012017:Referral and Consultation; D057566:Self Report; D016896:Treatment Outcome