Is There Gender Discrimination in Acute Renal Colic Pain Management? A Retrospective Analysis in an Emergency Department Setting

Background: Pain is a widespread problem, affecting both men and women; studies have found that women in the emergency department receive analgesic medication and opioids less often compared with men. Aims: The aim of this study was to examine the administration and management of analgesics by the medical/paramedical staff in relation to the patients' gender, and thereby to examine the extent of gender discrimination in treating pain. Design: This is a single-center retrospective cohort study that included 824 patients. Settings: Emergency department of tertiary hospital in Israel. Participants/Subjects: The patients stratified by gender to compare pain treatments and waiting times between men and women in renal colic complaint. Methods: As an acute pain model, we used renal colic with a nephrolithiasis diagnosis confirmed by imaging. We recorded pain level by Visual Analog Scale (VAS) scores and number of VAS examinations. Time intervals were calculated between admissions to different stations in the emergency department. We recorded the number of analgesic drugs administered, type of drugs prescribed, and drug class (opioids or others). Results: A total of 824 patients (414 women and 410 men) participated. There were no significant differences in age, ethnicity, and laboratory findings. VAS assessments were higher in men than in women (6.43 versus 5.90, p =.001, respectively). More men than women received analgesics (68.8% versus 62.1%, p =.04, respectively) and opioids were prescribed more often for men than for women (48.3 versus 35.7%, p =.001). The number of drugs prescribed per patient was also higher in men compared with women (1.06 versus 0.93, p =.03). A significant difference was found in waiting time length from admission to medical examination between non-Jewish women and Jewish women. Conclusions: We found differences in pain management between genders, which could be interpreted as gender discrimination. Yet these differences could also be attributed to other factors not based on gender discrimination but rather on gender differences.