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A study in the Journal of the American Medical Association’s JAMA Pediatrics found a racial disparity in doctors’ decisions whether to give painkillers to children with acute appendicitis, NBC News reports.

The researchers reveal that 41 percent of children overall received an opioid drug for pain, but just 12 percent of black children received the synthetic narcotic painkillers. Experts blame a combination of unwarranted fear of opioids and unconscious bias against black children.

“Our findings suggest that although clinicians may recognize pain equally across racial groups, they may be reacting to the pain differently by treating black patients with nonopioid analgesia, such as ibuprofen and acetaminophen, while treating white patients with opioid analgesia for similar pain,” the researchers said, according to NBC.

These findings are not surprising. Dr. Eric Fleegler and Dr. Neil Schechter of Boston Children’s Hospital and Harvard Medical School say the research supports a historic pattern. “There is a substantial body of evidence documenting health care disparities during the past three decades, including disparities in pain management,” said the doctors in a commentary published with the study, according to the news report.

The report also noted that it’s possible that most black children are not asking their doctors for pain relief. If that’s true, doctors should simply ask the children if they want pain medication, the researchers suggest.

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This study is based on national survey data from 2003 to 2010. It includes more than 900,000 children receiving treatment for acute appendicitis.

Read more at NBC News.