Mechanisms of injustice: what we (do not) know about racialized disparities in pain

Over-Rating Pain is Overrated: A Fundamental Self-Other Bias in Pain Reporting Behavior

“…49 Biased pain treatment congruent with false stereotypes about pain exaggeration constitutes and perpetuates mechanisms of injustice that create disparities in pain. 11,20,35 Such disparities may be magnified by the counter-stereotypical realities of pain reporting behavior documented by the current findings. When people are accurately or under-reporting their pain and still experience discounting by their healthcare provider, the needs of the person in pain are even less likely to be met.…”

“…6,53 Further, epistemic injustice is one mechanism by which racism and sexism are institutionalized. 35,41 Interpreted in this context, the present findings spotlight false beliefs that are used to justify and uphold epistemic injustice, and arguably contribute to poorer patient outcomes and pain disparities. Specifically, current findings suggest that precise pain reporting is the normative goal of patients and that specific groups whose experience is particularly doubted, if anything, tend to underreport (and not over-report) their pain in most contexts.…”

“…These findings oppose dominant cultural assumptions that women over-report their pain, as well as biased assumptions reflected in inequitable skepticism of the pain reports of women and Latinx Americans. 20,25,59,60,[34][35][36]40,49,50,55,56 However, we interpret these results cautiously, as our sample sizes for these within-group analyses were small. Further, the clinical experiences of the young adults in this sample may have limited generalizability.…”

“…18 Similar to other painrelated stereotypes and biases, it is possible that skepticism of pain reports is a) culturally-rooted, b) predates and shapes clinical training, and c) expands beyond clinical contexts to be observable among laypeople and clinicians alike. 33,35,55,56 Generalized beliefs that people over-rate their pain have the potential to undermine pain assessment and compromise pain management in clinical settings, diminish empathy and validation, and increase the stigmatization of the pain of others more broadly.…”

“…Critically, skepticism of pain reports is applied inequitably − women and people from racialized groups are less likely to have their pain believed − leading to disparities in pain treatment. 20,25,[34][35][36]40,49,50,55,56,59,60 To counteract and avoid biased treatment, women and people from racialized groups engage in effortful work to appear more credible and maintain dignity in clinical reporting of their pain, including concealing or underrating the severity of their pain from healthcare providers. 21,30,37,38,61 Additionally, those whose pain is typically undermined may also be less skeptical of the pain reports of others.…”