Two patients can arrive at a hospital with similar pain and leave with very different experiences.

One feels heard.

The other spends hours trying to prove that something is wrong.

Understanding why requires confronting an uncomfortable fact about healthcare: medical decisions are made by human beings, and human beings can carry assumptions into the examination room.

Race and the History of Pain

Racial disparities in American medicine didn’t appear from nowhere.

False beliefs about biological differences between racial groups have existed for generations. Some historical myths portrayed Black people as experiencing pain differently or having bodies fundamentally different from white people.

Race is not a biological pain scale.

Yet researchers have found evidence that some of these false ideas persisted into modern medical education.

In a widely cited 2016 PNAS study, Kelly Hoffman and colleagues studied white medical students’ and residents’ beliefs about biological differences between Black and white people. About half of the sample endorsed at least one false belief presented by the researchers. Among participants who endorsed more false beliefs, Black patients’ pain was rated lower and treatment recommendations were less accurate in the study scenarios.

That doesn’t mean half of physicians intentionally discriminate against Black patients.

It means inaccurate beliefs can survive even in highly educated environments—and potentially influence clinical judgment.

Disparities Beyond One Study

Research conducted across emergency, surgical, pediatric, and other settings has repeatedly investigated racial and ethnic differences in analgesic treatment.

Not every study finds the same disparity, and healthcare has changed considerably over time. We should be careful about turning complex research into claims such as “Black patients always receive less pain medicine.”

They don’t.

But systematic reviews and individual studies have found enough evidence of unequal pain treatment to make racial and ethnic disparities an important patient-safety and health-equity issue.

Sickle cell disease provides an especially important example.

Pain crises can produce extreme pain and repeated emergency visits. Because patients may know precisely which treatments have worked previously and may return to hospitals repeatedly, they can also encounter stigma and suspicion. Professional guidelines increasingly emphasize rapid assessment and individualized pain-management plans.

What About Women’s Pain?

Gender creates another complicated picture.

Research has examined differences in pain perception, pain prevalence, diagnosis, and treatment between men and women. Women experience a high burden of several chronic pain conditions, yet studies and patient reports have also raised concerns about women’s symptoms being attributed to psychological or emotional causes.

The history matters here as well. Medicine has a long record of interpreting women’s symptoms through assumptions about emotion, anxiety, and reproductive biology.

But the evidence deserves careful wording.

It would be inaccurate to say that every woman receives less pain medication than every man. Treatment differences vary according to condition, setting, clinician, and study.

The larger issue is whether gender influences how symptoms are interpreted and how quickly clinicians investigate their cause.

Bias Can Affect Many Patients

Race and gender aren’t the only factors that can influence pain care.

Older adults may have difficulty communicating pain or may be particularly vulnerable to medication side effects. People with dementia or developmental disabilities may express pain differently. Patients who don’t speak English fluently can encounter communication barriers. People with mental-health diagnoses may have physical symptoms attributed prematurely to psychiatric causes.

Patients with substance-use histories face another powerful form of stigma: the assumption that requests for pain relief are requests for drugs rather than requests for care.

These categories can also overlap.

A Black woman with chronic pain and a previous opioid prescription isn’t experiencing each identity separately when she enters a hospital. Clinicians encounter the whole person—and assumptions can accumulate.

What Equitable Pain Care Looks Like

Equity doesn’t mean giving every patient identical medication.

It means using the same seriousness, curiosity, and clinical standards when evaluating every patient’s suffering.

One person may safely receive an opioid while another shouldn’t. One may need imaging or surgery. Another may benefit most from an anti-inflammatory medication, nerve block, physical intervention, or treatment of the disease causing the pain.

The outcome doesn’t have to be identical.

The opportunity to be heard and properly assessed should be.

Hospitals can support that goal through consistent assessment, evidence-based protocols, interpreters, individualized treatment plans, careful documentation, bias awareness, and access to pain and addiction specialists when cases become complex.

For patients, one of the most powerful questions may simply be:

“If you don’t think this treatment is appropriate, can you explain what you think is causing my pain and what the alternative plan is?”

Pain treatment will always require clinical judgment.

Equitable healthcare requires making sure assumptions don’t take its place.

Research starting points

• Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. PNAS. 2016;113(16):4296–4301.
• Agency for Healthcare Research and Quality (AHRQ), National Healthcare Quality and Disparities resources.
• American Society of Hematology, evidence-based guidelines for management of acute and chronic pain in sickle cell disease.
• Peer-reviewed systematic reviews examining racial/ethnic disparities in pain assessment and analgesic treatment.