Racial and ethnic disparities in postpartum pain: a systematic review

Abstract

Background

Racial and ethnic disparities in obstetric analgesia and anaesthesia exist globally. However, little is known about disparities in postpartum pain assessment, intensity, and treatment. These disparities are complex and may be influenced by interlinked factors including social determinants of health. We aimed to review the evidence of disparity related to pain in the postpartum period.

Methods

We conducted a systematic review to systematically summarise literature related to racial and ethnic disparity in postpartum pain frequency assessment, severity and opioid prescribing. Relevant observational studies were identified from a previous systematic review and supplementary reference screening.

Results

Eight observational studies involving 22,259 patients were included. All included studies were conducted in the United States (n=7) or the United Kingdom (n=1). Five examined pain after caesarean delivery, and three assessed all delivery modes. Studies showed disparities in reporting of pain, with higher pain scores reported by Black and Hispanic patients when compared with White patients. Black patients were also less likely to receive equivalent analgesic medication doses when compared with White patients.

Conclusions

Racial and ethnic disparities persist in pain frequency assessment, intensity and analgesic prescribing during the postpartum period. Further research is needed to elucidate the reasons underpinning these disparities, particularly the role of structural and institutional factors, to guide the development of equitable patient-centred approaches to minimise them.