Ethnic differences in pain perception and patient-controlled analgesia usage for postoperative pain

J Pain. 2008 Sep;9(9):849-55. doi: 10.1016/j.jpain.2008.04.004. Epub 2008 Jun 12.


There are reports suggesting that sensitivity to and tolerance of both clinical and experimental pain differ among ethnic groups. We examined self-rated pain score and morphine usage in 1034 women who underwent elective lower cesarian section (LSCS) for their deliveries. Data on pain scores and amount of total morphine use according to patient-controlled analgesia were collected every 4 hours. Overall, lowest pain scores were recorded 12 hours after surgery and highest at 24 hours. Morphine consumption was highest within the first 4 hours and lowest between 12 and 16 hours. There were statistically significant ethnic group differences in pain scores (P = 1.7 x 10(-7)) and morphine usage (P = 2.8 x 10(-15)) between ethnic groups, with Indians having the highest mean pain score and using the highest amount of morphine. The ethnic differences in pain score and morphine self-administration persisted after controlling for age, body mass index, and duration of operation.

Perspective: Our findings of highly significant ethnic group difference in self-reported pain level and the amount of analgesia self-administered may have implications on optimal management of acute postoperative pain. Inadequate management of pain after cesarian deliveries might affect the emotional well-being and physical recovery of patients and affect mother-child bonding.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Analgesia, Patient-Controlled / methods*
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use
  • Body Mass Index
  • Cesarean Section
  • China
  • Female
  • Humans
  • India
  • Injections, Intravenous
  • Malaysia
  • Morphine / administration & dosage
  • Morphine / therapeutic use*
  • Pain Measurement / methods
  • Pain Threshold / psychology
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / ethnology
  • Pain, Postoperative / psychology*
  • Patient Satisfaction
  • Postoperative Period
  • Pregnancy
  • Time Factors


  • Analgesics, Opioid
  • Morphine