Feeling the Pain: Racial bias in health care calls for more awareness

In the realm of healthcare, pain management is a critical component, yet it remains marred by racial disparities. Notably, Black Americans frequently face under-treatment for pain compared to their white counterparts. This inequity is a stark reminder of the systemic racism embedded within the U.S. healthcare systems.

Studies have shown that Black patients are less likely to receive pain medications, and when they do, the dosages are often lower than those prescribed to whites with similar needs. A 2016 study by the University of Virginia revealed that a significant number of white medical students and residents held false beliefs about biological differences between Blacks and whites, impacting their pain assessment and treatment recommendations. These misconceptions contribute to the under-treatment of pain in Black patients.

That is why one registered nurse working on the South Side encourages her patients to be their own best advocate when dealing with chronic pain.  “Linda Jones*” has worked in nursing for over 19 years, serving both surgical and medical patients at large and mid-size hospitals. 

She told the Crusader, “Our people have to learn to be their own best advocate when dealing with pain management and the level of care they receive in these hospitals and clinics,” she said. “The racial bias that exists in our day-to-day lives also exists in health care. If doctors aren’t prescribing appropriate pain medications, I tell people to stay calm or your chart will get tagged as ‘drug seeking,’ and to immediately seek alternative solutions.”

The 45-year-old, award-winning nurse also noted that those who suffer from “nerve pain” have a more difficult time finding sustained, long-term relief. Treatments can include intravenous (IV) delivery for in-patient care or the administration of medicines such as oxycodone, oxymorphone, codeine, hydromorphone, morphine, and methadone, among others. 

African American and younger patients experiencing chronic pain were more likely to present with chronic pain syndrome, according to health care studies. Black patients presenting with chronic pain syndrome or disability with mild pain syndrome reported a higher disability than their counterparts. Older patients and women within the good pain control cluster reported a lower level of pain and depression, reported the Journal of Pain.

“Patients are at the mercy of the doctor who has been given new guidelines on what type and how much pain medications can be prescribed, Jone said. “There is this preconceived notion that we (Blacks) are either drug-seeking or that we have a higher tolerance for pain, so a lot of physicians will prescribe high dosage over-the-counter medications such as extra strength Tylenol. White patients receive blue-ribbon treatment, are prescribed stronger drugs and for longer periods of time, versus the typical seven-to-10-day supply (of an opioid) to a Black patient.”

The nurse, who was not authorized to speak on behalf of her employer, also told the Crusader, that prior to the CDC guidelines on opioid prescriptions, she personally witnessed perceived racial bias in practice at a number of Chicago area hospitals. 

“I worked in their pain management center and I saw Black sickle cell patients being given extremely high doses of opioids but without the proper education to go along with that,” she said. “You can’t just dope people up either. A lot of those patients wound up dying from complications of taking those drugs from things like heart failure or liver disease.” 

In response to the national opioid crisis, the Centers for Disease Control and Prevention (CDC) issued guidelines in 2016 for prescribing opioids for pain, which are intended to help doctors and patients make informed decisions about pain management and reduce the risks of opioid misuse, addiction, and overdose.

These guidelines recommended that doctors should use non-opioid therapies as the first-line treatment for chronic pain and that they should prescribe the lowest effective dose of opioids for the shortest duration possible.

According to the Illinois Department of Public Health, opioid overdose deaths in Illinois have increased dramatically in recent years, especially due to the rise of synthetic opioidsOx such as fentanyl. In 2020, there were 2,944 opioid overdose fatalities in Illinois, a 33 percent increase from 2019. This was more than twice the number of fatal motor vehicle accidents and more than twice the number of homicides in the state.

These sorts of dire statistics illustrate why treating chronic pain with more potent narcotics is a lane made more difficult to navigate since the state cracked down on opioid usage. 

Assessment of chronic pain is multifaceted, often complicated by patient medical comorbidities and a complex set of biopsychosocial/spiritual/financial and legal determinants. These complexities are further exacerbated by a patient’s race, provider bias, and structural barriers intersecting and culminating in disparate outcomes.

The implications of these disparities are profound. Inadequate pain management can lead to chronic pain, reduced quality of life, and increased healthcare costs. It also exacerbates the mistrust between Black communities and healthcare providers, further widening the racial gap in healthcare access and outcomes.

That is why some advocates believe addressing this issue requires a multi-faceted approach. Medical education must prioritize cultural competency and debunk myths about racial biological differences. Healthcare providers need to be trained to recognize and counteract their biases in pain assessment and treatment.

Additionally, policy interventions are essential to ensure equitable pain management practices, as noted by the 2021 study, “Treatment Disparities Among the Black Populations and Their Influence on the Equitable Management of Chronic Pain.”

Many studies also noted that healthcare professionals are examining ways to reduce patient reliance on prescribed narcotics. However, many African Americans have alleged that even after major surgery or being diagnosed with diseases that lead to chronic pain, they are unable to get the assistance they need.

“I once had a surgery after a really bad car accident and they sent me home with four pain pills,” said Washington Park homeowner, L. Miller. “I was told to only take them if needed, which was crazy to me because I just had surgery. When I got home, I couldn’t walk and the pain was shooting so bad—I called the doctor and asked for more Vicodin but they told me to go to 

Walgreens and get some ibuprofen. There was nothing I could do, except deal with it.”

Mrs. Miller, 71, said she thought about changing doctors or going to another hospital to see if they would prescribe her the pain medications she needed. However, a friend warned her that “ she “could be labeled as a hospital hopper” a term used for people who frequent various healthcare services to treat a single injury. “I didn’t want them thinking I was some sort of crackhead,” Miller added. “I didn’t want that in my medical record.”

And yet, healthcare workers admit that doctors can only prescribe so much for both legal and medical reasons.

“I encourage patients to look for alternatives such as weight loss, diet change, increased exercise, using hot pads, or even relieving constipation,” Jones said. “Nothing will fully help those with pinched nerves and patients can become desensitized to steroid injections over time. If chronic pain persists people should get a new evaluation and by all means seek emergency treatment if pain becomes unbearable.”

*Linda Jones is a requested pseudonym per courtesy of the Crusader.

Reporting made possible by the Inland Foundation and the Chicago Crusader black health care initiative.