Pain inequity within the Black community is rooted in centuries of historical oppression and systemic racism. Additionally, the attitudes around pain tolerance have far-reaching consequences for Black individuals’ health and well-being. BlackDoctor.org sat down with physician and health equity expert Dr. Uché Blackstock to discuss the key factors contributing to pain inequity in the Black community, how it differs from experiences in other racial or ethnic groups and what can be done to ensure equitable access to pain management and treatment for Black patients.
What are the key factors contributing to pain inequity within the Black community, and how does it differ from other racial or ethnic groups?
There are very deep historic and systemic roots to pain inequity in Black communities. These roots stretch back to slavery, a societal institution that was falsely based on and perpetuated the notion that Black people were biologically inferior to other races. Enslaved Black people were experimented on, without their consent, and traumatized during slavery to help the medical establishment to make important discoveries that benefited society. They were put on display in medical school lecture halls, and even textbooks included myths that Black people were biologically different. Those notions and myths have been perpetuated for centuries and still infiltrate our medical education curricula.
How do these disparities manifest in healthcare settings?
Pain inequity is an acute public health crisis in the Black community. Ninety-three percent of Black people interviewed for the Advil survey, in partnership with the Morehouse School of Medicine, said that pain impacted their day-to-day lives and 3 out of 4 believed that bias and discrimination were involved in how their pain was diagnosed and treated. Black patients’ concerns are often minimized and even ignored by health professionals.
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What are some common misconceptions or stereotypes about pain perception and tolerance among Black individuals, and how do they impact healthcare outcomes?
Some of the myths and stereotypes that health professionals hold about Black people and pain include, Blacks have a higher pain tolerance, thicker skin, less sensitive nerve endings and that we are biologically different than people of other races. These are myths and categorically false. Many of these myths were believed by students and residents in a 2016 study done at the University of Virginia. This mythical thinking is very much current day as well.
What role do healthcare providers play in perpetuating pain inequity, and what steps can be taken to address this issue within the medical profession?
Healthcare providers can perpetuate pain inequity by not listening to Black patients, not treating their pain adequately, not properly investigating the source of their pain, and not making the correct diagnosis. All healthcare providers should have continuing medical education and training about pain inequity. For example, part of their continuing medical education should be watching and discussing the powerful videos on the Believe My Pain website and bearing witness to the stories of Black people living with the pain. Also, their workplaces should develop pain equity metrics for healthcare providers that can be measured, tracked, and then intervened upon, if necessary.
What are the potential consequences of unaddressed pain inequity in the Black community, both in terms of individual health outcomes and broader societal implications?
If pain goes untreated, people experience physical, emotional and psychological distress. They cannot enjoy activities of daily living, like spending time with family and friends. They are unable to work and cannot pay their bills. Even worse, they likely have a clinical diagnosis that is being missed or delayed that could potentially harm them or ultimately result in their death.
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What strategies or interventions can healthcare institutions implement to reduce pain inequity in the Black community and ensure equitable access to pain management and treatment?
Healthcare institutions must recognize systemic racism detrimentally impacts the health and well-being of their Black patients and hold themselves accountable. They must use a multi-pronged effort to combat pain inequity. We already know that many of these racist myths can be perpetuated in medical education and training. The Advil Pain Equity Project is working with the Morehouse School of Medicine and BLKHLTH to develop a pain equity course for medical schools. This course will be very important since we know that the next generation of health professionals holds the key to changing how we care for patients. Healthcare institutions must also implement rigorous clinical protocols and processes to track pain inequity in practice and intervene when necessary.
How can healthcare providers improve communication with Black patients regarding their pain experiences and needs?
Healthcare providers must recognize the internal racial biases they hold and how those biases can negatively impact the care they provide to Black patients. They should make sure that they are actively listening to Black patients’ concerns, responding competently based upon those concerns to find an answer for their pain, and then make sure to adequately treat their patients’ pain.
