Our Emergency Room on the 200-year old Exam Table: Nineteenth-Century Medicine, Twenty-first Century Disparities, and their Integration through a Large Database and Modern Statistics

Racial/ethnic and sex disparities in modern acute pain management have been well-documented since the 1990s. Multiple studies have used national databases to show that nonwhites are less likely than white non-Hispanics to... [ view full abstract ]

Racial/ethnic and sex disparities in modern acute pain management have been well-documented since the 1990s. Multiple studies have used national databases to show that nonwhites are less likely than white non-Hispanics to receive opioids and analgesics for the same disease processes. Studies of sex disparities are less conclusive, but suggest that men and women do not receive the same treatment when presenting with pain. As we probe why, when, and in what ways these disparities occur in modern medicine, nineteenth-century concepts of pain can be an important framework. 

My paper details how our research group used nineteenth-century hierarchies of race and gender as applied to pain and pain sensitivity to investigate twenty-first century disparities in acute pain management at the intersection of race and sex. We considered how theories such as Dr. Samuel Cartwright’s dysaethesia aethiopicaand the cult of true womanhood created a climate in which whites were believed to feel pain more severely than blacks, and women more than men in the nineteenth century. We then questioned how these constructs shaped our own current particular, peculiar, and non-physiologic understanding about who feels pain and how much—and hypothesized about the receipt of analgesia for men as compared to women within and across racial groups in twenty-first century emergency departments.  In other words, we were interested in how the climate around pain has been transmitted and transmuted across the centuries to lead to current disparities in acute pain management.