Kenneth Glad
Medical care depends on trust, urgency and careful judgment. Evidence suggests those protections are not always shared equally.
Research from several countries points to a persistent divide in how pain is recognised and treated for patients from minority ethnic backgrounds.
The concern is not limited to one hospital department or one stage of life. It can affect care from childhood injuries to childbirth, chronic illness and the final months of cancer treatment.
A 2024 University of Delaware study found that participants were slower to identify pain in black boys than in white boys when shown computer-generated children’s faces.
That hesitation matters, because those who recognises less pain are also less likely to recommend treatment.
Early warnings are missed
Children’s National Hospital research found another divide in US emergency rooms. Children from minority ethnic groups with fractures were less likely to receive opioid pain relief, even when injury severity and pain levels were considered.
Dr Monika Goyal said: “When looking at optimal pain reduction, minority children were more likely to be discharged home in significant pain compared with their white counterparts.”
Similar assumptions can surface during childbirth, where minutes can change outcomes. UK maternity evidence cited by The Guardian included accounts of Black women feeling stereotyped as able to tolerate more pain, while Asian women were described in ways that suggested they were demanding or unable to cope.
One woman said: “I feel like, for us black ladies, they feel like we can handle the pain, even when we are complaining we are in pain.”
Bias can follow illness
A Boston University study found Black patients in the US were much less likely than white patients to receive opioid medication for pain-related emergency visits. For sickle cell patients, the Sickle Cell Society has reported delays, disbelief and failures to meet pain-relief standards during severe crises.
The pattern continues beyond emergency rooms. Studies reported by The Guardian found Black patients with chronic lower back pain described more severe pain, while Black and Asian patients with Parkinson’s were less likely than white patients to receive pain relief.
Near the end of life, pain control can determine whether a patient spends their final months in avoidable distress. University of Hull researchers found that cancer patients from Black, South Asian, mixed and other ethnic backgrounds received fewer opioid prescriptions and lower doses than white patients.
Jonathan Koffman, a professor of palliative care at the University of Hull and the study’s lead researcher, said: “Adequate pain relief is a human right.”
The findings suggest that unequal pain treatment is not a single failure point, but a recurring risk across health care systems.
Sources: The Guardian, University of Delaware study, Children’s National Hospital research, Sickle Cell Society, Hematology.org, University of Hull.
