Racial and Ethnic Bias in Pain Assessment and Treatment

 Racial and Ethnic Bias in Pain Assessment and Treatment

Consider this: if asked whether Black people are less sensitive to pain than white people, would you answer true or false?

What if you were asked whether Black people have thicker skin than white people?

Or if Black people have less sensitive nerve endings than white people?

Do you think Black people’s blood coagulates more quickly than white people’s blood?

These questions, to which the correct answer for all is that there is no biological difference between Black and white people, were posed to over 200 U.S. medical students and residents (Hofmann et al. 2016).

The results? A whopping 50% believed that at least one of the biological differences between Black and white people was true or could be true.

What’s more is that medical students and residents who held more false beliefs about biological differences about pain between Black and white people also rated the pain severity of fictional Black subjects to be lower than that of fictional white subjects. And those who had higher ratings for false beliefs were less accurate in their pain treatment recommendations for the fictional Black subjects than for the white subjects.

These findings are far from surprising given rampant anti-Black prejudice in the U.S. and beyond, particularly in the practice of medicine. Many popular false beliefs about differences between Black and white people originated in the practice of medicine and were concocted in order to rationalize the enslavement of Black people (Hofmann et al. 2016). By postulating that Black people were less sensitive and more likely to experience bad health than white people, white physicians helped set in motion a legacy of heinous medical abuses of Black people (Ghoshal et al. 2020).

The impact of medical prejudices about Black people as well as Indigenous and other People of Color (BIPOC) continue to create a gulf of health care disparities in general and inequitable pain care in specific. Compared to white patients, BIPOC patients receive less pain screening and comprehensive pain treatment and referrals across age, condition, and gender (Ghoshal et al. 2020, Meints, Cortes, & Edwards 2019). False stereotypes about BIPOC populations being drug seekers and opioid abusers further result in less pain relief. Forced tapering of opioids for BIPOC patients already using them without abuse is also greater compared to forced tapering of white patients.

Even if a practitioner’s treatment decisions are ultimately accurate or not at issue, practitioner bias can have a traumatic, and lasting, impact on patients. Numerous studies utilizing the Implicit Association Test (IAT), which measures one’s level of implicit bias toward a particular population, have found that physicians who have high implicit bias scores regarding the population at hand interact differently with these patients, such as spending less time with these patients and being more condescending toward them (Ghoshal et al. 2020, Meints, Cortes, & Edwards 2019).

Health and medical practitioners also frequently lack an understanding of cultural and individual differences in how patients of different ethnic backgrounds vary in describing their pain and its severity.

Some programs to address medical practitioner racial and ethnic bias have been introduced to teach cultural humility, sensitivity, and critical consciousness, but this is not enough. If there is any hope of changing systemic medical bias, it is imperative that BIPOC and people from other marginalized populations have access to opportunities to become health care providers, particularly in the field of pain medicine, and advance in administrative roles (Ghoshal et al. 2020).

With that said, prioritizing true diversity in hiring and promotion to leadership roles must take into account structural changes that are needed to make these roles possible (Togioka, Young, & Duvivier 2021).

Expecting marginalized people to operate in roles engineered for and historically dominated by straight, white, non-disabled cisgender men—whose work relied upon unpaid or subsistence wage labor of women, BIPOCs and disabled people—without substantively revising these positions to reflect the needs of diverse employees is a sure fire way to prevent equity and diversity despite all so-called “best efforts.”

Thank you for reading!

Here is a brand new study for further reading: Negative Patient Descriptors: Documenting Racial Bias in the Electronic Health Record.

Please check back for my article about sexism and gender bias in pain assessment and treatment, coming February 8, 2022.

For more about medical bias, read my post Addressing Medical Practitioner Bias in Pain Treatment.

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Sources

Ghoshal, Malini, et al. “Chronic Noncancer Pain Management and Systemic Racism: Time to Move Toward Equal Care Standards.” Journal of Pain Research, Volume 13, 2020, pp. 2825–2836. doi:10.2147/jpr.s287314.

Hoffman, Kelly M., et al. “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites.” Proceedings of the National Academy of Sciences, vol. 113, no. 16, 2016, pp. 4296–4301., doi:10.1073/pnas.1516047113.

Meints, S. M., Cortes, A., Morais, C. A., & Edwards, R. R. (2019). Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Management, 9(3), 317–334. https://doi.org/10.2217/pmt-2018-0030.

Togioka, B. M., Young, E., & Duvivier, D. (2021, March 21). Diversity and Discrimination In Healthcare. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/33760480/.