Perceptual contributions to racial bias in pain recognition

Abstract

The pain of Black Americans is systematically under-diagnosed and under-treated, 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 nine total experiments (N = 1289) 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.

The need for diversity in research on facial expressions of pain

“…One recent study found that White participants require more evidence to recognize pain in Black American faces compared with White American faces. 16 This in-group bias parallels a large literature on biased emotion perception in the United States 9 and directly links with the pain disparities mentioned above. Furthermore, it is still unknown if there are cultural or ethnic differences in the expression of pain.…”

“…Although researchers have begun to look for mechanisms underlying health inequities in pain, 6,12,16 a lack of diverse samples and over‐reliance on White stimulus sets has limited researchers' ability to evaluate whether facial expressions or their assessment contribute to disparities in pain. One recent study found that White participants require more evidence to recognize pain in Black American faces compared with White American faces.…”

The Delaware Pain Database: a set of painful expressions and corresponding norming data

“…Because of this diversity, researchers may better examine how pain-related outcomes vary based on these sociodemographic variables, promoting better understanding of disparities in pain care. 19 Indeed, stimuli from the DPD have been used to demonstrate that racial bias in pain perception facilitates disparities in treatment in white perceivers, 56 and further, that racial bias in pain perception is exacerbated by bottom-up and top-down cues to racial prototypicality. 20…”

“…One may circumvent this limitation by morphing neutral and painful images from the DPD to create dynamic expressions. 20 , 56 Using morphing software, a researcher can produce morphs representing points along the continuum from one face to another or generate a video transitioning from a neutral face to a painful face.…”

“…Creation and norming of a smaller set of computer-generated pain expressions was described in a recent investigation of racial bias in pain perception (experiments 6–7 in Ref. 56 ).…”