Racial Bias Found in Pain Assessment, Management, Treatment Recommendations by Clinicians

Dr. Bradley

“This suggests that central sensitization is greater among African American persons with knee osteoarthritis and may contribute to enhanced clinical pain,” according to Laurence A. Bradley, PhD, professor of medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham (UAB), a co-author of the study.

Dr. Bradley is one of several investigators at the University of Florida and UAB collaborating on a study of ethnic differences in pain among adults with OA through a grant funded by the National Institute of Aging, The research points to the need to better understand what underlies the ethnic differences in pain responses, as well as change in these responses. To examine this, the investigators are conducting a five-year longitudinal study to look at biological and psychosocial variables that may contribute to ethnic differences in pain at baseline, as well as change in pain two years later.

Results of the longitudinal study will help determine what differences in biological and psychosocial variables may contribute to the enhanced perception of pain found among black patients with OA. Until then, evidence from the 2014 study that suggests there is a biological difference between black and white persons in pain perception raises the question of whether this may lead to another form of racial bias when diagnosing and treating pain in patients.

What do clinicians do with this sort of information? How will these data affect treatment recommendations? Will black patients be offered higher doses of pain medications? Will white patients be undertreated?

Complexity of Treatment Bias

Highlighting the complexity of the impact of beliefs on action (i.e., treatment recommendations) is a finding in the study by Hoffman and colleagues that found no racial bias in treatment recommendations among white medical students and residents who did not endorse or endorsed fewer false beliefs about black patients and also reported that white patients experienced less pain than black patients.

Unlike the white medical students and residents who held false beliefs that blacks felt less pain than whites and therefore recommended inaccurate treatment, the opposite wasn’t true among those students and residents who did not endorse or endorsed fewer false beliefs about black patients and reported that white patients experienced less pain. In this case, no racial bias was seen in treatment recommendation.

“It thus seems that racial bias in pain perception has pernicious consequences for accuracy in treatment recommendations for black patients and not for white patients,” say the authors in the study.¹