Racial Bias in Pain Perception and Response: Experimental Examination of Automatic and Deliberate Processes

Abstract

Racial disparities in pain treatment pose a significant public health and scientific problem. Prior studies demonstrate clinicians and non-clinicians are less perceptive, and suggest less treatment for, the pain of African Americans, relative to European Americans. Here we investigate the effects of explicit/implicit patient race presentation, patient race, and perceiver race on pain perception and response. African American and European American participants rated pain perception, empathy, helping motivation, and treatment suggestion in response to vignettes about patients’ pain. Vignettes were accompanied by a rapid (implicit), or static (explicit) presentation of an African or European American patient’s face. Participants perceived and responded more to European American patients in the implicit prime condition, when the effect of patient race was below the level of conscious regulation. This effect was reversed when patient race was presented explicitly. Additionally, female participants perceived and responded more to the pain of all patients, relative to male participants, and in the implicit prime condition, African American participants were more perceptive and responsive than European Americans to the pain of all patients. Taken together, these results suggest that known disparities in pain treatment may be largely due to automatic (below the level of conscious regulation), rather than deliberate (subject to conscious regulation) biases. These biases were not associated with traditional implicit measures of racial attitudes, suggesting that biases in pain perception and response may be independent of general prejudice. Perspective Results suggest racial biases in pain perception and treatment are at least partially due to automatic processes. When the relevance of patient race is made explicit, however, biases are attenuated and even reversed. We also find preliminary evidence that African Americans may be more sensitive to the pain of others than European Americans.

Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

“…Conversely, participants who endorsed fewer false beliefs (−1 SD) rated the black target as feeling more pain than the white target [β = −0.48, SE = 0.20, t(211) = −2.34, P = 0.020]. In other words, as in study 1, participants in study 2 who endorsed false beliefs about biological differences between blacks and whites exhibited a racial bias in pain perception similar to the bias shown in previous work (11)(12)(13)(14)(15)(16)(17). Unexpectedly, participants who did not endorse such beliefs exhibited a bias in the opposite direction.…”

“…This opposite bias could also reflect participants' attempt to compensate for known racial disparities (see ref. 13 for a similar explanation). Of note, these medical students and residents did not exhibit a racial bias in treatment recommendations.…”

“…In fact, recent work suggests that racial bias in pain treatment may stem, in part, from racial bias in perceptions of others' pain. This research has shown that people assume a priori that blacks feel less pain than do whites (11)(12)(13)(14)(15)(16)(17). In a study by Staton et al (14), for instance, patients were asked to report how much pain they were experiencing, and physicians were asked to rate how much pain they thought the patients were experiencing.…”

Shared Decision Making Among Clinicians and Asian American and Pacific Islander Sexual and Gender Minorities: An Intersectional Approach to Address a Critical Care Gap

“…65 Ways to improve SDM with AAPI SGM range from simple recognition and awareness of implicit and automatic biases to more complex institutionalized changes to clinic culture and procedures. [22][23][24][25][26]36,[38][39][40][42][43][44][45][46]66,67 These changes include eliciting sexual orientation and gender identity in a culturally competent manner, and training providers and AAPI SGM to empower patients to expect competent care and to take appropriate actions if they do not receive it (Table 2).…”

Stereotyping Patients

“…Evidence that health professionals' assessments of the pain of their patients can be influenced by implicit biases is found in a study undertaken by Vani Mathur et al (). These authors found that experimental participants implicitly primed with a picture of a Black face prior to considering a case study perceived and responded to the pain described in the study less than those who were implicitly primed with a White face.…”