Though chronic pain should be the one thing that doesn’t discriminate, evidence shows that that’s not the case. Race and ethnicity are strongly tied to how you experience chronic pain — they influence its severity, length, and treatment. Sadly, in this case, this influence brings nothing good; ethnic minorities struggle with chronic pain more and receive inadequate treatment.
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To learn how to help minorities deal with chronic pain more successfully, we need to understand the causes that worsen their experience. Most of them have to do with prejudice and bias — so if we remove those, minorities might not struggle quite as much.
What Is Chronic Pain?
Your body responds to injury or illness with pain— that’s its way of warning you that something’s wrong. When you address the pain’s cause and cure it, it goes away and leaves no lasting damage. This type of pain is called acute pain, and we’ve all experienced it at some point.
But on the opposite side of the spectrum, there is chronic pain, which lasts longer than six months and may seriously affect your mental well-being and daily life. This pain doesn’t go away even after the cause has been addressed sometimes the cause is entirely unknown.
Sadly, there is no cure for chronic pain — or at least, none that can guarantee complete recovery. However, proper treatment and rehabilitation can offer some relief and make life with pain more bearable.
Biopsychosocial Model of Chronic Pain
In the past, doctors believed that one’s biology was the only thing that caused and shaped pain. If your stomach ached, a doctor following the biomedical model of diagnosis had to look for a physical cause, such as inflammation.
This approach usually works for acute pain, but chronic pain requires more nuance.
That’s where the biopsychosocial model comes in. This model doesn’t focus solely on biology — instead, it considers patients as a whole. Their backgrounds, mental health, social status, values, and attitudes can perpetuate or relieve chronic pain. Biology still plays a part, but a much smaller one than you would expect.
Ethnicity and Its Influence on Chronic Pain
Ethnicity may be defined as being a part of a certain group based on biological, psychological, social, and cultural similarities with the other members. People of the same race may share values, beliefs, and attitudes, which are key factors in the biopsychosocial model. Most studies agree that race has a huge impact on pain perception, its intensity, and treatment.
Compared to white patients, African American, Hispanic, and Asian people tend to be more sensitive to pain. They report greater pain severity, a higher level of disability, poorer life quality, and difficulty getting treatment.
The differences in physiology between these races are partly to blame — but so are how they emotionally experience pain. And as it happens, non-white patients tend to have a more emotional response to it than white ones.
Pain catastrophizing is a tendency to think of and describe pain in more exaggerated terms, resulting in helplessness. Patients who do that often report their pain as more severe than those who don’t.
Sadly, African Americans and Asians engage in pain catastrophizing more than whites. That certainly contributes to their overall higher sensitivity and more emotional response to chronic pain.
Luckily, there is a way to break this pattern of negative thoughts related to pain — by attending cognitive behavioral therapy.
When dealing with chronic pain, all races turn to coping strategies that help them push through and function despite it. However, these strategies differ greatly among various races. For instance, white people are more likely to ignore the pain and use coping self-statements. That way, they feel like they still have some degree of control.
In contrast, African American people use more “passive” coping skills, such as praying, distraction, and hoping the pain goes away. These strategies take control away from the patient, increasing disability, and depression.
It’s important to note, though, that African Americans rely on coping mechanisms much more than whites. That helps them decrease pain.
Depression, Anxiety, and Stress
Patients with depression or anxiety tend to report higher pain sensitivity levels than those without any mental health issues. At the same time, though, chronic pain is one of the leading causes of depression, stress, and anxiety, which creates a vicious cycle that is hard to escape.
And compared to white patients, Asian ones are more prone to anxiety and depression. As a result, their pain threshold is lower, and they are more sensitive to pain overall.
Why Ethnicity Influences Chronic Pain
From what we’ve seen so far, it’s obvious that ethnicity does influence pain perception and experience. But the real question is — why does it do that? What are the underlying mechanisms that cause these differences between white people and people of color when it comes to chronic pain?
Well, as it turns out, there are a few possible causes:
Though human physiology is more or less the same across all races and ethnicities, there are still some minor differences. These are responsible for varying reactions of the body to illness, medicine, and of course, pain. Here are a few that may contribute to African American patients experiencing chronic pain more intensely:
Nociceptive Flexion Reflex
Nociceptive flexion reflex (NFR) is a reflex that activates a withdrawal response when you are exposed to painful stimuli. Since it’s involuntary and objective, doctors use it as a clinical tool that measures a person’s pain experience. NFR is certainly more reliable than the patient’s account, which can often be biased and colored by emotions.
When doctors measured the NFR threshold in white patients and African American ones, they noticed a glaring difference. Namely, African Americans have a reduced NFR threshold, which means that they are biologically more sensitive to pain. That proved to scientists across the globe that socio-cultural factors aren’t enough to explain the difference in pain perception.
Conditioned Pain Modulation
You might have experienced this before — your stomach aches. Still, then you cut your finger, and suddenly, it’s like the stomachache is gone. This phenomenon is called conditioned pain modulation (CPM).
CPM largely depends on the effective functioning of a pain-inhibitory system called the endogenous opioid system. As research shows, African Americans have reduced conditioned pain modulation when compared to whites. What that means is that the endogenous opioid system, which helps inhibit pain, isn’t as effective in African American people.
Different races have different cultural, traditional, and religious responses to pain. As we’ve already seen, non-white patients — particularly African American ones — have a more emotional reaction to pain and use “passive” coping skills.
They also report higher levels of disability when compared to white patients. But there are a few other factors to consider:
Sadly, the less educated you are, the more likely you are to suffer from chronic health issues. A Finnish study showed that people over 60 with only basic education experienced longer chronic pain after a whiplash injury than those with higher education. There is a possible explanation for this phenomenon — patients with lower education aren’t as likely to visit a doctor when they have a problem.
Of course, people of color don’t necessarily have to be less educated — but sadly, sometimes, that is the case due to limited opportunities. Still, when a non-white person has the same level of education as a white person, the differences in pain severity and disability aren’t as great. That proves that education does have a key role.
Perception of Pain
Perception always plays a large part in how you experience something, and pain is no exception. If you think of pain as unbearable and impossible to cope with, you will struggle with it more than if you tried to accept it. Accepting that chronic pain is a part of you that you might not be able to get rid of but could control is the first step in the healing process.
Unfortunately, as you already know, ethnic minorities are prone to pain catastrophizing. Due to that, they might perceive pain as much worse than it is, causing them to struggle more than a white patient.
Treatment and Provider Factors
Inadequate treatment and care may perpetuate chronic pain intensity and disability. Sadly, the ones who are most likely to receive such care are minorities — African American, Asian, and Hispanic patients.
That doesn’t mean that all doctors are racist or culturally insensitive. But in many cases, certain unconscious biases play a part in improper treatment.
Wrong Beliefs About an Ethnic Group
Among medical practitioners, there is an old and certainly outdated belief that non-white patients are more likely to abuse analgesics. To prevent them from developing an addiction or overdosing, doctors prescribe lower medication doses to minorities, even if their pain is more severe.
Though there is clear evidence that white patients are more likely to overdose, this belief persists among many doctors. Due to that, minorities are unable to receive appropriate doses for their chronic pain conditions. Ultimately, that explains why their pain severity and level of disability are higher.
Empathy Based on Skin Color and Shared Language
As research shows, people tend to be more empathetic toward those who are similar to them. For instance, a Spanish-speaking doctor will sympathize with Hispanic patients more than with those who speak only English. Likewise, a white doctor will be more understanding of the struggles of white patients.
On top of that, subconscious stereotypes and biases might further widen the gap between doctors and their ethnic minority patients. And since the majority of doctors are still white, it might be difficult for ethnic minorities to receive the care they deserve.
Lack of Cultural Training and Competence
Sadly, it’s still difficult to find culturally sensitive doctors who will approach their non-white patients with empathy and care. That’s not entirely their fault — part of the blame lies within the system that doesn’t provide cultural training for doctors. Still, to do their job properly, doctors should attempt to educate themselves on cultural issues and actively work to accommodate their patients.
And finally, the system itself may contribute to the pain severity and lack of proper treatment for minorities. People with a lower socioeconomic status usually have the poorest health, no matter if they have access to proper healthcare or not. Life expectancy is the longest in the countries where wealth is distributed more equally, even if the average income isn’t the highest.
Sadly, ethnic minorities tend to be the ones with a lower socioeconomic status in general. That may account for the fact that they suffer from chronic pain much more than their white counterparts.
African American people are the only exception to this rule. They struggle with their health no matter the income, even when it’s the same or higher than that of white people.
Systematic discrimination may be another cause of minorities’ struggle with chronic pain. Many African American, Asian, and Hispanic patients feel that healthcare professionals mistreat them based on their race. Feeling discriminated against naturally causes stress, and stress worsens chronic pain. Thus, it’s easy to imagine why minorities have a harder time dealing with it.
Ethnic differences in pain management and perception are real and may cause many struggles for minority group members. Doctors often don’t take their complaints seriously, lack cultural competence, or refuse to prescribe them medication due to biases. All of that leads to additional stress and worsens chronic pain.
But ethnic minorities don’t have to suffer more than others — all it takes is some educating. Doctors and pain specialists need to go through cultural competence training to help them empathize with ethnic minorities. They should be aware that the problems these patients are facing are real — not just exaggerations. Only then will they be able to approach them properly and treat them as they deserve.