Pain is a universal experience, yet the way it is treated varies widely. Medicine’s goal is to help alleviate and manage pain to improve functionality and quality of life. However, too often, pain is undertreated in diverse populations, women and older patients. For decades, pain management research has consistently documented inequities in the quality of care experienced by these individuals, leading to variations in pain medication strength and quantity.
Pain is subjective, hard to measure, and outward signs are often invisible, this may contribute to the inequities in pain management. Inadequate treatment for pain can significantly decrease a patient’s quality of life, have significant mental and emotional health implications, lead to long-term disability, and in some cases, contribute to a person’s death. It can contribute to the risk of infection, poor healing, scarring, decreased mobility and further injury to weakened muscles or joints. People living with chronic pain are also at a heightened risk for mental health problems, including depression, anxiety and substance use disorders.
Despite an increased focus on health equity and clinical recommendations, studies confirm that Black American patients, of all ages, are often denied adequate pain medication and are 19% less likely to be prescribed opioids compared to White Americans with similar conditions. This bias is widespread and persists across a variety of healthcare settings, including hospital emergency rooms, chronic pain treatment centers, Veterans Hospitals and more. This inequity is not limited to controlled substances, studies also show that non-opioid options for pain control are also under prescribed. A meta-analysis study found that Black individuals are 22% less likely than White individuals to receive any pain medication.1
Racial disparities are also prevalent in pediatric pain management. Research shows that race appears to affect the odds that a child or teen will receive appropriate and adequate pain control. From appendicitis, a painful condition requiring surgery, to bone fractures, or conditions known to cause severe pain such as sickle cell disease, studies have shown that Black and Hispanic children do not receive the same pain control measures as White children. Additional studies have found that children from minority backgrounds are also more likely to be misdiagnosed with or have a delayed diagnosis compared to those from majority backgrounds. Prompt diagnosis and medical intervention are critical for conditions such as appendicitis treatment and acute sickle cell crisis. If left untreated these conditions can lead to disability and in some cases, death.
In 2013, the American Medical Association published a review of the relationship between pain and ethnicity in its Journal of Ethics. It concluded that variations in treatment stem in part from racial misconceptions about heightened pain tolerance among Black Americans and from the false belief that Black Americans and Hispanic Americans are more likely than White Americans to abuse drugs. Studies have also shown that a significant number of medical students and healthcare professionals hold false beliefs about Black individuals and their pain. As recently as 2016, studies have shown that up to 40% of 1st and 2nd-year medical students hold false beliefs tied to antebellum slavery, including the belief that Black individuals have thicker skin and fewer nerve endings.2
This implicit bias occurs automatically and unintentionally, and often times a person is unaware of the implicit biases they hold. But not recognizing individual biases requires intervention because it affects healthcare professionals’ critical judgments, decisions, and behaviors, and most importantly, it affects people who are in need of care. Racial economics, including language barriers, inadequate insurance, and cultural differences, also fuels racial profiling. By raising awareness around this issue and investing resources into equitable health services and solutions, healthcare systems can start making progress towards reducing disparities and providing quality healthcare for everyone.
Learn more about the current state of health equity and gain insights from our first annual Health Equity Benchmark Survey.
- Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States – PubMed (nih.gov), How we fail black patients in pain | AAMC
- Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites | PNAS
