Perceptual contributions to racial bias in pain recognition.

Abstract

The pain of Black Americans is systematically underdiagnosed and undertreated, compared to the pain of their White counterparts. Extensive research has examined the psychological factors that might account for such biases, including status judgments, racial prejudice, and stereotypes about biological differences between Blacks and Whites. Across seven experiments, we accumulated evidence that lower-level perceptual processes also uniquely contribute to downstream racial biases in pain recognition. We repeatedly observed that White participants showed more stringent thresholds for perceiving pain on Black faces, compared to White faces. A tendency to see painful expressions on Black faces less readily arose, in part, from a disruption in configural processing associated with other-race faces. Subsequent analyses revealed that this racial bias in pain perception could not be easily attributed to stimulus features (e.g., color, luminance, or contrast), subjective evaluations related to pain tolerance and experience (e.g., masculinity, dominance, etc.), or objective differences in face structure and expression intensity between Black and White faces. Finally, we observed that racial biases in perception facilitated biases in pain treatment decisions, and that this relationship existed over and above biased judgments of status and strength, explicit racial bias, and endorsement of false beliefs regarding biological differences. A meta-analysis across 9 total experiments (N = 1,289) confirmed the robustness and size of these effects. This research establishes a subtle, albeit influential, perceptual pathway to intergroup bias in pain care and treatment. Implications for racial bias, face perception, and medical treatment are discussed.

Medical education and distrust modulate the response of insular-cingulate network and ventral striatum in pain diagnosis

“…As unfortunate drawback, estimated reliability might be vulnerable to biases, including those related to the social and ethical condition of the patient. Previous studies showed that confronting individuals from different social and ethnic group can impact profoundly representation of trust and associated activity in VS (Hughes et al, 2017;Stanley et al, 2012Stanley et al, , 2011, but also sensitivity to their pain (Avenanti et al, 2010;Mende-Siedlecki et al, 2019) including the neural responses in AI and dACC (Cao et al, 2015;Hein et al, 2010;Xu et al, 2009). As such, the interplay between the reward system and AI-dACC network might offer a plausible model to explain why specific social/ethnic categories are less likely to be acknowledged for their pain and receive adequate treatment.…”

Racial and Ethnic Disparities in Discharge Opioid Prescribing From a Hospital Medicine Service

“…28 Individually and interpersonally, there is clinician-driven bias in pain assessment, which is activated under times of stress and diagnostic uncertainty and is amplified by a lack of clear guidelines for pain management prescriptions. 23,[29][30][31][32] Institutional and organizational culture contribute to disparities through ingrained culture, practice patterns, and resource allocation. 29,33 Last, public policy and the larger sociopolitical environment worsen disparities through nondiverse workforces, state and federal guidelines, criminal justice policy, supply chain regulation, and access to care.…”

The stigmatized perceiver: Exploring the implications of social stigma for cross‐race face processing and memory

“…Perceivers can also readily extract social category information from faces; social neuroscience researchers have demonstrated that information about basic social category membership like race, sex, and age are available within the first hundreds of milliseconds of encountering a face (Ito & Urland, 2003;Macrae & Bodenhausen, 2000), and that these category memberships inform subsequent face processing (Hugenberg & Corneille, 2009). Thus, face perception informs interactions between dyads and groups, with the potential to create and maintain societal disparities across a wide range of domains (e.g., healthcare, education, hiring practices, voting decisions, sentencing decisions; e.g., Mende-Siedlecki et al, 2019;Todorov et al, 2005;Wilson & Rule, 2015). For example, Wilson and Rule provide evidence that stable facial characteristics (i.e., trustworthiness) can influence criminal justice decisions -including death-penalty determinations.…”