From: Reuters
Published February 11, 2008 12:23 PM

African Americans less open to epidural for pain

NEW YORK (Reuters Health) - African Americans are less willing than whites to have an epidural to ease pain following surgery, a new study suggests.

This could mean poorer pain relief in the short term, and possibly a greater risk of chronic pain in the long run, according to researchers.

Epidurals involve injecting a local anesthetic into the lower spine, and they are considered the most effective form of pain relief following certain types of surgery -- including procedures done in the chest or abdominal cavities.

However, both African Americans and lower-income patients may be less willing to accept a post-surgery epidural, according to the new findings, published in the journal Anesthesia and Analgesia.

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Of the nearly 1,200 surgery candidates researchers questioned, black patients were about 40 percent less likely than white patients to say they would accept an epidural. Similarly, patients with annual incomes above $50,000 were more likely to want an epidural than lower-income patients were.

The reasons for these discrepancies are not clear, but they suggest that black and lower-income patients may be at a disadvantage after surgery, according to the researchers, led by Dr. E. Andrew Ochroch, of the University of Pennsylvania School of Medicine in Philadelphia.

"Epidurals are more effective for relieving postoperative pain, and higher levels of pain have been linked to the development of chronic pain," Ochroch explained in a statement.

"Consequently," he said, "if African Americans are either denied or denying themselves epidural for pain relief, then they may be at greater risk for postoperative complications."

Of the 1,193 patients the researchers interviewed, 64 percent said they would accept an epidural if their anesthesiologist recommended it. Thirty-six percent said they would refuse.

It's not clear why race and income influenced the likelihood of patients' acceptance, according to the researchers. Access to medical information, whether from reading, watching TV or surfing the Web, did not offer an explanation. Nor did access to healthcare.

According to the researchers, surgeons and hospital staff may need to find "innovative ways" to discuss the potential benefits of epidural pain relief with surgery patients, particularly African Americans.

SOURCE: Anesthesia and Analgesia, December 2007.

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