Patient Language and Differences in Administration of Analgesia for Pelvic Pain

Objectives

Patient-provider language discordance is known to impact medical care; however, whether patient language is associated with differences in analgesia administration has not been well studied. This study aimed to evaluate the association between patients’ primary language and analgesia administration among women seeking emergency care for acute pelvic and abdominal pain.

Study Design

We conducted a retrospective cohort study to assess the association between patient language and differences in administration of analgesic medications to non-pregnant adult women presenting to the emergency department (ED) with a primary diagnosis of abdominal or pelvic pain. The primary outcome was the receipt of any analgesic medication. Secondary outcomes were receipt of opioid medications, receipt of intravenous analgesia, and association between diagnosis and receipt of analgesia.

Results

Among 817 patients, 427 spoke English and 390 spoke another primary language. More than half (53.7%) were given some form of pain medication, with 211 (25.8%) receiving an opioid and 228 (27.9%) receiving only non-opioids. On bivariate analysis, there is no difference between whether any analgesic was administered between those with and without English as their primary language (52.9% and 54.6%, respectively, p = .65). However, those who spoke English as a primary language were more likely to receive an opioid analgesic (53.1% vs. 42.7%, p = .038). Among individuals who received at least one analgesic, those with English as a primary language had an adjusted odds ratio [95% confidence interval] of 1.49 [1.02, 2.20], p = .04, for receipt of an opioid when adjusted for highest pain score. Patients with abdominal pain were more likely to receive any analgesic (55.6% vs. 45.0%, p = .049) and more likely to receive opioid pain medication compared with those with pelvic pain (52.4% vs. 22.1%, p < .001).

Conclusions

Abdominal and pelvic pain in women may be undertreated in the ED setting, particularly among those for whom English is not the primary language and those presenting with the primary diagnosis of pelvic pain.