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Perceptions of Pain: Black Adults and Children Seeking Medical Care Get Shortchanged

Additional reporting by Sheryl Estrada

The false notion that Black patients experience less pain than white patients leads to disturbing disparities in how medical professionals treat people of different races. A recent study found that half of medical students surveyed believed one or more falsehood about how Black people experience pain, including that Black people’s skin is thicker than white people’s, that Black people’s nerve-endings are less sensitive than white people’s, and that Black people’s blood coagulates faster than white people’s. These perceptions also affect children.

A 2015 study “Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments,” also found that there are racial differences in the administration of anesthesia and painkillers for Black youth suffering from acute appendicitis in the U.S.

“There has been literature documenting racial disparities in the pain management of adults,” lead author Dr. Monika K. Goyal of the Children’s National Health System in Washington, D.C., told DiversityInc. “Our goal was to determine whether these racial disparities also existed in the care of children.”

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The study found only 56.8% of youth evaluated in emergency departments diagnosed with appendicitis received pain medication, and about 41.3% received at least one dose of an opioid, such as morphine and fentanyl.

Out of that total, Black patients in severe pain were 80% less likely than white patients to receive opioids for their pain. Approximately 21% of Black patients, compared with more than 40% of white patients, received opioids. Black patients with moderate pain were also less likely to receive any pain medication compared to white patients.

(Credit: From “Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments”)

Goyal’s team wrote that while clinicians may recognize pain equally across racial groups, they may be reacting to the pain differently by treating Black patients with painkillers, such as ibuprofen and acetaminophen, while treating white patients with opioids for similar pain.

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(Credit: From “Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments”)

“This analysis by pain strata suggests that there may be a higher threshold of pain score for administering analgesia to Black patients with appendicitis,” the authors wrote.

Goyal said she was surprised the results of their research demonstrated such dramatic differences in opioid administration by race.

“We assess pain scores in the emergency department, meaning, we ask patients to rate the pain they are experiencing,” Goyal told DiversityInc. “We should be responding to the pain scores the patients provide us.”

The current study was not designed to understand why these disparities exist, so Goyal and her team are planning studies to further delve into the topic in order to “help inform the development of interventions to achieve health equity.”

“I believe that the causes of such racial disparities are multifactorial,” she explained, “which include both conscious and unconscious bias, institutional practices, parental preferences,and societal expectations.”

Goyal explained racial disparities in health care are also a societal issue.

“We are all accountable for these disparities,” Goyal said. “I hope that our work makes us acknowledge that these disparities exist and motivates us to all work towards creating a more equitable health care system.”


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