Reports of pain are discounted, and that has been measured
In 9,900 women after birth at one US hospital, the women who reported the most pain received the least medicine for it.
If you think being told your symptom is normal is a soft harm, this is the hard version. It is not a story about listening in the abstract. It was counted.
Researchers looked at every delivery at one high-volume US academic centre over twelve months, 9,900 women in all, and compared what women reported with what they received.
| Compared with non-Hispanic white women | Hispanic women | Non-Hispanic Black women |
|---|---|---|
| Reporting a pain score of 5 or more at discharge | 1.61 times the odds (1.26 to 2.06) | 2.18 times the odds (1.63 to 2.91) |
| Opioid pain medicine given per day as an inpatient | Lower, by 5.03 morphine milligram equivalents (6.91 to 3.15 lower) | Lower, by 3.54 (5.88 to 1.20 lower) |
| Given a prescription for pain medicine at discharge | 0.80 times the odds (0.67 to 0.96) | 0.78 times the odds (0.62 to 0.98) |
These are relative figures, and so are the concordance figures in the callout below. Both studies report adjusted odds ratios and adjusted differences, not the plain percentage of women in each group who got a prescription, so no absolute rate can honestly be printed alongside either set. That limitation belongs with the numbers, and it is stated here rather than filled in by guesswork.
The authors' own conclusion: Hispanic and non-Hispanic black women experience disparities in pain management in the postpartum setting that cannot be explained by less perceived pain.
One caveat the authors report themselves, and so does this guide: in a further analysis that matched women more closely to one another, the difference in inpatient pain medicine between white and Black women no longer reached statistical significance. The discharge prescribing difference held.
Disparities in postpartum opioid prescribing and pain perception are not ameliorated by patient-prescriber racial and ethnic concordance.
This is a system problem, not a matching problem, and it is not something an individual woman can solve by being more polite about her pain.
"What is the maximum I am allowed, and am I getting it?"
"Please write in the notes that I reported this level of pain and what was given."