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I'm Rob Logan, Ph.D., senior staff, U.S. National Library of Medicine substituting this week for Donald Lindberg, M.D, the Director of the National Library of Medicine.

Here is what's new this week in MedlinePlus.

To listen to Dr. Lindberg's comments, click here

Emergency room patients, who are white, receive more pain relievers than other Americans, finds a recent study published in the Journal of the American Medical Association.

Researchers primarily based at the University of California-San Francisco found all emergency room patients received significantly more pain relievers nationwide during a 13 year period. Of the approximately 375,000 emergency department visits assessed in the study, about 42 percent were pain-related. Overall, the use of opioid analgesic pain relievers increased from about 23 to 37 percent in a sample of U.S. emergency rooms from 1993-2005.

Moreover, the study, which provides the most comprehensive, nationwide data to date, confirmed previous research that white emergency room patients (especially children) receive more pain relievers than Hispanics, blacks, and Asians.

The study's four authors attribute the overall increase in pain prescriptions to recent campaigns by the Joint Commission of Health Organizations and the Veterans Health administration to improve the consistency of treatment for pain and pain control in the nation's hospitals. In other words, the authors find the overall trend of an increase in pain reliever prescriptions is therapeutic -- and reflects better care in the nation's emergency rooms.

The study, which was based on findings from the National Hospital Ambulatory Medical Care Survey, is generalizeable to all U.S. emergency departments during the period surveyed. However, the study did not specifically assess why there might be differences in pain reliever prescriptions among emergency room patients based on ethnicity. So, the study's otherwise insightful data does not provide specific reasons why white patients received more pain relievers than others.

While studies in the 1990s (that were based on previous data from the same source) found a similar trend among persons with back pain and migraine headaches and for sedating children with serious bone fractures, the current research is the first to account for a wide range of opioid analgesic prescriptions across a stratified sample of emergency rooms of varying sizes nationwide.

Opioid analgesics are narcotic drugs taken to manage pain; they work by depressing the central nervous system. Opioids are the most powerful analgesics and used to treat severe acute pain, such as after-surgery, or for burns. Similar to all narcotics, opioid analgesics can be habit-forming if used for long periods. Besides dependence, other side effects include: drowsiness, dizziness, and breathing problems.

It should be noted that the study focused on the likelihood that a patient would receive a pain prescription, rather than the dose a patient received.

The study did not find significant differences in overall ages of white versus nonwhite patients, nor differences in gender, severity of pain, or a prevalence of previous alcohol or drug problems.

Among several possible explanations for disparities in pain management in emergency rooms, the authors write and we quote: 'it is conceivable that these prescribing differences represent a degree of overprescribing among white patients' (unquote).

The authors conclude that new strategies are needed to understand and improve the quality and equity of managing acute pain in the U.S. Among their recommendations, the authors suggest that future efforts concentrate on promoting cultural competence education among physicians as well as better training about pain management for nurses (as well as other health providers in emergency settings) and for patients as well.

MedlinePlus contains two health topic pages that provide insights on both pain management and the problems associated with prescription and non-prescription narcotic drugs.

First, MedlinePlus' pain health topic page contains a good overview of pain management from the American Pain Foundation. The overview contains: an explanation of common pain terms, setting up a pain management plan, questions you should ask a physician, drug treatment options, and a variety of non-drug - pain treatment options, such as exercise and rehabilitation.

The link to this information is called 'treatment options: a guide for people living with pain (American Pain Foundation),' which is located in the 'treatment' section of MedlinePlus' pain health topic page.

Among the many other options on this page include information on: disease management, coping, some specific conditions (such as nerve and chest pain), current related clinical trials underway both nationally and internationally, and the latest research findings from leading medical journals.

To find MedlinePlus' pain health topic page, simply type 'pain' in the search box on MedlinePlus' home page. Then, click on 'pain (National Library of Medicine).'

MedlinePlus' drug abuse health topic page page adds information on the serious side effects from narcotic prescription and illegal street drugs. There is a succinct patient page on opioid addiction sponsored by the Journal of the American Medical Association (the same journal that published the current study). The patient page on opioid addiction is in the 'specific conditions' section of MedlinePlus' drug abuse health topic page.

To find MedlinePlus' health topic page on drug abuse, simply type 'drug abuse' in the search box on MedlinePlus' home page. Then, click on 'drug abuse (National Library of Medicine).'

Similar to the pain health topic page, the drug abuse information covers the latest research, links to available clinical trials, and details a variety of conditions. The drug abuse health topic page also has good sections for children, teens, men, women, seniors, and supplies information in several languages, including Spanish, Russian, Vietnamese, and Korean.

Perhaps the most interesting thing about the current study is it notes both some positive and negative aspects of pain management for emergency care patients. While the study notes that the increased use of opioid analgesics in emergency rooms may be a sign of progress, it also details some differences in prescription rates along ethnic lines that could be signs of overmedication, or an illustration of health disparities in patient care. The study raises many questions for the future, which MedlinePlus will follow.

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