While pain is a universal experience, numerous studies show that clinicians disproportionately dismiss, underestimate, or undertreat pain suffered by people of color, women, and patients of lower-socioeconomic status. Racial and gender bias in medicine has led some healthcare professionals to provide inadequate medical assessments or treatments because they believe that Black people experience less pain than White people, or that women overreact to their pain.
Reducing these biases and disparities in pain management requires a multifaceted approach by healthcare professionals, researchers, policymakers, and patient advocates, according to a new commentary by a School of Public Health researcher.
Published in the journal Health Equity, the commentary discusses the origins of disparities in pain management and identifies strategies that can promote equity in clinicians’ assessment, diagnosis, and treatment of patients experiencing pain, focusing on improvements in healthcare delivery, research, policy, and advocacy.
“Targeting inequities in pain management requires comprehensive, multisectoral strategies that go beyond hospital walls,” says lead author Monica Wang, associate professor of community health sciences, who penned the commentary with Olivia Jacobs, PhD student in the Center for Innovation in Social Science at BU’s College of Arts and Sciences. “Broader systemic and structural changes need to be implemented to improve overall patient outcomes, including improving and standardizing pain assessment tools, protocols, and trainings; investing in health equity intervention research to inform changes in practice; and advocating for policies that promote better access and quality care in pain management.”
Improving and standardizing pain assessment protocols is paramount, the authors argue. There are no standardized protocols to measure or diagnose pain, and the current tools that healthcare providers use—such as clinical exams and self-reporting—are not designed to accurately assess a variety of populations. These updated guidelines should also incorporate cultural sensitivities that can be tailored to individual patients, the authors write.
“Cultural beliefs and language can significantly impact how patients experience and report pain, and cultural values influence how patients make health care decisions, including pain treatment,” the authors write. “Demonstrating respect for how patients may express pain differently and may prefer different approaches to pain management can facilitate more equitable pain management outcomes.”
Wang and Jacobs also urge physicians and patients to embrace shared decision-making that respects the doctor’s expertise, as well as the knowledge, experiences, values, and preferences of the patient.
“By discussing different options (with an emphasis on approaches available and accessible to patients and their specific circumstances), providers can increase patient awareness of the spectrum of treatment plans, promote patient autonomy, and enhance adherence to care,” they write.
Together with evidence-based interventions and broader, structural policy changes that improve access to and quality of pain management, these strategies can inform medical care that is both equitable and effective.
Click here to read the full commentary.