Influence of patient sex on pain management practices in Paramedicine: A rapid review

Objective: Pain is a subjective multidimensional experience that impacts an individual's physical, emotional, and mental wellbeing. Paramedics are regularly contacted to alleviate pain, in both an emergency and non-emergency capacity. Patient presentation, assessment tools, and clinical judgement, together influence paramedic decision making, and therefore pain management practices will inevitably vary. This research aimed to identify the nature and description of sex-specific discrepancies in the literature in relation to paramedic pain management. Methods: Using the Cochrane rapid review methodology, a search of five electronic databases and nine paramedic-specific journals was conducted on 8 November 2023. Articles were included if they: investigated ambulance presentations of pain; analysed pharmacological analgesic management; compared management between the sexes; and reported on either medication type, dosage, time to administration, or pain score. Eligible articles were assessed for risk of bias and subjected to narrative synthesis. Results: A total of 2545 articles were identified during the systematic search, resulting in 13 studies eligible for inclusion. Seven studies indicated a sex disparity in the administration of analgesia after controlling for confounders, with females statistically less likely to receive analgesia, particularly opioids, compared to males. Five studies found that sex had no effect on analgesic administration. One study noted female paramedics provided better analgesia overall, while two studies found paramedic sex had no influence on analgesic decisions. Five studies indicated that the higher the pain score, the greater the likelihood of analgesic administration, with three studies highlighting that the analgesia provided was effective in reducing pain score. Conclusions: While some studies identified no sex-specific differences in relation to paramedic pain management, a greater number of studies indicated a gender-disparity, where females were found to have higher risk of oligo-analgesia. Ideal pain management practices were demonstrated in the literature, with higher pain scores correlating to increased rates of analgesia.