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Impact of Physician and Patient Gender on Pain Management in the Emergency Department—A Multicenter Study


  • Funding: The Pain and Emergency Medicine Initiative was supported by a generous grant from The Mayday Fund, New York, New York.

Basmah Safdar, MD, Section of Emergency Medicine, Department of Surgery, Yale University, New Haven, CT 06520 USA. Tel: 203-737-2489; Fax: 203-785-4580; E-mail:


Objective.  Pain is a complex experience influenced by factors such as age, race, and ethnicity. We conducted a multicenter study to better understand emergency department (ED) pain management practices and examined the influence of patient and provider gender on analgesic administration.

Design.  Prospective, multicenter, observational study.

Setting.  Consecutive patients, ≥8-years-old, presenting with complaints of moderate to severe pain (pain numerical rating scale [NRS] > 3) at 16 U.S. and three Canadian hospitals.

Outcomes Measures.  Receipt of any ED analgesic, receipt of opioids, and adequate pain relief in the ED.

Results.  Eight hundred forty-two patients participated including 56% women. Baseline pain scores were similar in both genders. Analgesic administration rates were not significantly different for female and male patients (63% vs 57%, P = 0.08), although females presenting with severe pain (NRS ≥8) were more likely to receive analgesics (74% vs 64%, P = 0.02). Female physicians were more likely to administer analgesics than male physicians (66% vs 57%, P = 0.009). In logistic regression models, predictors of ED analgesic administration were male physician (odds ratio [OR] = 0.7), arrival pain (OR = 1.3), number of pain assessments (OR = 1.83), and charted follow-up plans (OR = 2.16). With regard to opioid administration, female physicians were more likely to prescribe opioids to females (P = 0.006) while male physicians were more likely to prescribe to males (P = 0.05). In logistic regression models, predictors of opioids administration included male patient gender (OR = 0.58), male patient–physician interaction (OR = 2.58), arrival pain score (OR = 1.28), average pain score (OR = 1.10), and number of pain assessments (OR = 1.5). Pain relief was not impacted by gender.

Conclusion.  Provider gender as opposed to patient gender appears to influence pain management decisions in the ED.

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