Pain is one of the most common reasons people seek medical care.

Yet for some hospitalized patients, getting someone to believe that they are hurting can become almost as difficult as dealing with the pain itself.

Pain presents a unique challenge because there is no blood test that tells a clinician exactly how much another person hurts. Heart rate, blood pressure, imaging, and laboratory results may provide clues, but pain remains a personal sensory and emotional experience. A patient can have severe pain while appearing calm, talking normally, looking at a phone, or even laughing with family.

That doesn’t make the pain unreal.

The Consequences of Uncontrolled Pain

Poorly controlled acute pain isn’t simply uncomfortable. Severe pain can interfere with sleep, movement, coughing and deep breathing, physical therapy, and recovery after illness or surgery.

It can also create fear.

A patient who learns that moving will cause excruciating pain may stop moving. Someone recovering from abdominal or chest surgery may avoid coughing because it hurts. Another patient may become anxious as the time for the next medication approaches because previous doses haven’t provided adequate relief.

Modern pain management therefore isn’t simply about making someone comfortable. It can be an important component of recovery.

Why Pain Can Be Difficult to Assess

Clinicians have a difficult responsibility. They need to relieve suffering while also considering sedation, falls, medication interactions, respiratory depression, kidney and liver function, and the potential risks associated with opioids.

But appropriate caution can become something different when assumptions about a patient replace an individualized assessment.

Research has documented disparities in pain assessment and treatment associated with race and ethnicity, while other research has raised concerns about differences associated with sex and gender, age, disability, mental-health diagnoses, substance-use history, and communication barriers.

Bias does not necessarily mean someone consciously decides to mistreat a patient. Implicit assumptions can influence how people interpret behavior.

One patient may be described as “stoic.”

Another may be described as “dramatic.”

A patient repeatedly requesting pain relief may be considered appropriately concerned in one circumstance and “drug-seeking” in another.

Those descriptions can matter because they become part of the story clinicians tell themselves—and sometimes document for the clinicians who come next.

What Research Has Found

One frequently cited 2016 study published in Proceedings of the National Academy of Sciences examined false beliefs about biological differences between Black and white people among medical students and residents. Some participants endorsed false beliefs, and those beliefs were associated with differences in pain assessment and treatment recommendations in the study.

The findings are disturbing because medicine has a long history of racial myths about pain and physiology.

Broader research has also identified racial and ethnic disparities in pain care in a number of clinical settings. The size and direction of disparities aren’t identical in every study, which is important to acknowledge, but the overall evidence has been significant enough to make equitable pain assessment an ongoing healthcare concern.

Pain Treatment Is Not the Same as Opioid Treatment

There is another distinction patients should understand: advocating for adequate pain control does not mean insisting that every episode of pain requires an opioid.

Modern pain management can include acetaminophen, anti-inflammatory medications when appropriate, local or regional anesthesia, medications targeting nerve pain, ice or heat, positioning, physical therapy, psychological strategies, and opioids when their benefits justify their risks.

This is often called multimodal pain management.

The goal isn’t the largest amount of medication possible. The goal is enough safe and appropriate treatment to allow a patient to rest, move, breathe, participate in recovery, and maintain a reasonable level of comfort.

When You’re Still in Pain

If pain isn’t controlled in the hospital, patients and families can ask specific questions:

• What is my current pain-management plan?
• When can this medication be given again?
• What non-opioid treatments are available?
• Is the medication scheduled or only available when I request it?
• What should I do if the medication isn’t working?
• Can the physician or pain-management team reassess me?

It can also help to describe function, not simply a number: “The pain is preventing me from taking a deep breath,” or “I cannot walk to the bathroom because the pain becomes unbearable.”

Patients shouldn’t have to perform suffering to deserve compassionate care.

Pain deserves thoughtful assessment. Medication deserves thoughtful prescribing. And hospitalized patients deserve to have both needs taken seriously.

Research starting points

• Hoffman KM, et al. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. PNAS. 2016.
• Agency for Healthcare Research and Quality (AHRQ), resources on pain management and healthcare disparities.
• CDC, clinical resources concerning pain care and opioid prescribing.