Racial Bias in Pain Assessment
Updated: Jul 13, 2020
Bias from medical professionals is very present for Black Canadians when it comes to mental health, as I discussed in an earlier piece. Another topic I’d like to look at is the bias that exists within physical healthcare as this no doubt also places stressors on Black Canadians’ mental health.
There is a trope we may all be familiar with; the strong Black woman. We often view Black women as strong, steadfast, as pillars of their family and community. While this may seem like a positive role model for young Black girls, and it can be, there is definitely a detrimental side to it. It means that Black women are expected not to show vulnerability, not to show what is perceived as weakness and this makes it harder for them to reach out and receive mental health treatment.
While this describes women and deals with psychological pain, it is important to note disparities that exist between physical healthcare for white and Black patients. Black people in general are often assessed differently when it comes to physical pain and this can have great effects on their mental health as well. The biases and stereotypes present within all facets of the healthcare system are very harmful to Black Canadians’ mental health.
Research has been done on how pain assessments are conducted for Black patients in comparison to white patients and the results support this. “False beliefs about biological differences between [Black patients] and [white patients] continue to shape the way we perceive and treat Black people – they are associated with racial disparities in pain assessment and treatment conditions.”
These false beliefs run deep within the medical community and inform the medical education received by students. A survey of 222 white medical students and residents showed that about half of them held false beliefs about the biological differences mentioned above. A major part of these beliefs was that Black patients feel less pain than their white counterparts. This paper was published in the Proceedings of the National Academy of Sciences.
These beliefs can often lead to inappropriate treatment suggestions such as over-prescribing for white patients and under-prescribing for Black patients. Under-prescription of pain meds for Black patients is a real and documented pattern.
This willful ignorance has persisted for centuries and been prevalent in many forms. For example, in the USA, beliefs such as these have been supported by scientists, physicians and slave owners alike to justify slavery and the inhumane use of Black people, especially women, in medical research.
These views endure and have a powerful impact on the care Black patients receive. One study suggested that the management of pain in emergency departments was impacted by racial and ethnic difference, with Black and Hispanic patients being prescribed opioids at a lower rate than white patients. “In a multivariable model with adjustment for age, ethnicity, sex, insurance status, triage level and pain score, Black patients were significantly less likely to receive opioid analgesia than white patients.” Being constantly belittled, disbelieved and invalidated when it comes to physical pain not only leads to considerable health risks and the potential for death but also sever mental health effects in the same vein of the microaggressions discussed in my earlier piece.
In both mental healthcare and physical healthcare, Black Canadians need to be heard, to be respected and to be treated as human, as valuable, and as a priority in the same way white patients are. Again, this is a systemic issue that goes beyond individuals and speaks to the medical education system that builds the foundation for these false beliefs.
Cartwright SA. Report on the diseases and physical peculiarities of the Negro race. New Orleans Med Surg J. 1851;7:691–715
Goyal, Monika K., et al. “Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments.” JAMA Pediatrics, vol. 169, no. 11, 2015, p. 996., doi:10.1001/jamapediatrics.2015.1915.
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.
Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Cleeland CS, Gonin R, Baez L, Loehrer P, Pandya KJ
Ann Intern Med. 1997 Nov 1; 127(9):813-6.