Variations in Pain Management Methods: For Non-Cardiac Chest Pain in an Academic Emergency Department

Document Type

Conference Proceeding

Publication Date

10-2026

Publication Title

Annals of Emergency Medicine

Abstract

Study Objectives: Pain management for non-cardiac chest pain is a regular part of emergency department (ED) care. Prior studies of acute and chronic pain have reported racial, ethnic, and sex-based differences in analgesic treatment, including lower rates of adequate pain treatment among racial and ethnic minority patients and women. However, treatment patterns for patients presenting specifically with non-cardiac chest pain (NCCP) are less well characterized. Among adults with NCCP presenting to a single academic ED, this Study’s primary Objective: was to evaluate whether analgesic selection, including opioid versus non-opioid administration, differed by age, sex, race, and ethnicity. Secondary Objectives: included evaluating route of medication delivery, initial pain scores, and change in pain score from initial to final documentation. Methods: We performed a retrospective cohort Study of patients 18 years or older presenting to a single, academic, high-volume ED in Michigan from January 1, 2021 to December 31, 2024. Patients were categorized as having NCCP if their final emergency department ICD-10 diagnosis was gastroesophageal reflux disease, costochondritis, musculoskeletal pain, or atypical chest pain. Patients with ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, trauma-related pain, chronic kidney disease, or cancer were excluded. Patient variables included age, sex, race, and ethnicity. Pain management variables included analgesic class administered, receipt of any opioid medication, route of administration, initial pain score, pain severity category, and change in pain score from initial to final documented score. Categorical variables were compared using chi-square or Fisher’s exact testing. Continuous variables were compared using t-tests, analysis of variance, Wilcoxon rank-sum testing, or correlation, as appropriate. Results: During the Study period, there were 389,512 adult ED encounters at the Study site, of which 6,063 met inclusion criteria for NCCP. Mean age was 46.2 years, and 66.6% of patients were female. The cohort was 46.8% Black, 44.3% White, and 8.9% Asian, other race, or unknown race. Most patients did not receive opioids during their ED visit, with opioids administered in 1,084 encounters (17.9%). Overall analgesic selection differed significantly by age, sex, race, and ethnicity. Females made up a higher proportion of the multiple-medication group, while males made up a higher proportion of the nonsteroidal anti-inflammatory drug (NSAID)-only group. There was no significant difference in opioid administration rates between male and female patients. Patients who received opioids were older than those who did not, with mean ages of 52.7 years and 44.8 years, respectively. Opioid administration rates differed significantly by race and ethnicity. Black patients made up 48.0% of the nonopioid-receiving group compared with 42.0% of the opioid-receiving group, while White patients made up 43.0% of the non-opioid-receiving group compared with 50.6% of the opioid-receiving group. Initial pain scores also differed by sex and race, with females reporting slightly higher median initial pain scores than males and Black patients reporting higher median initial pain scores than White patients. However, the median change in pain score from initial to final documentation was 0 [0,1] across sex and race groups. Conclusions: In this cohort of adults presenting with NCCP, analgesic selection varied by age, sex, race, and ethnicity. Opioid administration was more common among older patients and differed by race and ethnicity, although the percentage-point differences between groups were modest. There was no significant difference in opioid administration rates between male and female patients. These findings demonstrate measurable variation in ED pain management patterns for NCCP in this academic emergency department, but do not by themselves establish clinically meaningful disparities.

Volume

88

Issue

4 Suppl 1

First Page

S256

Comments

American College of Emergency Physicians (ACEP) Research Forum, October 5-7, 2026, Chicago, IL

Last Page

S256

DOI

10.1016/j.annemergmed.2026.08.587

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