Is there a difference in pain perception when a patient is seen by a doctor of the same ethnic group? The study by Anderson and colleagues(2) says so.
Background:
Pain is a subjective experience as it relies on personal assessment. Moreover, studies show that different groups may describe and perceive pain distinctly. Ethnicity also influences how patients deal with their pain.(1)
Therefore, more than an unpleasant sensation, we can think of pain as a socio-cultural
phenomenon.(1)
Racial and ethnic minorities often report higher pain levels in clinical and experimental settings.(2) They are also more likely to receive inadequate pain treatment compared to white patients.(2)
Understanding racial and cultural diversity can help healthcare providers avoid misjudging patients' pain and thus provide better care.(1)
To contribute to this understanding, Anderson and colleagues investigated patient-physician racial concordance and its influence on pain perception.(2)
Study Design:
One hundred and seven healthy adults (47 female; 37 Black, 34 Hispanic white, 36 non-Hispanic white) aged 18–30 years played the role of patients. A total of 13 healthy adults (six female; five Black, four Hispanic white, four non-Hispanic white) aged 19–22 years played the role of physicians.
Half of the patients were randomly assigned to a clinician who shared their racial/ethnic identity (concordant), while half were assigned to a discordant clinician.
About two weeks before the experiment, patients completed a trait-level online questionnaire.
Each patient participant completed one simulated clinical interaction with a clinician participant. At the same time, each clinician saw at least eight patients. All clinician-patient pairs were gender- and age-matched.
During the simulation, clinicians started from measuring the patients’ heat pain threshold and tolerance. The baseline thermode temperature was set at 38°C. The temperature increased at a 0.5°C/s rate to a maximum of 51°C.
Pain rating assessment consisted of applying a series of painful, yet tolerable, heat stimulations to four evenly spaced locations on the patient’s forearm for a sustained period of time. Each painful heat stimulation lasted about eight seconds and patients received up to 20 heat stimulations during each interaction.
For all thermal stimulations, clinicians used the Medoc Pathway Pain & Sensory Evaluation System (PATHWAY) with 16x16 mm thermode.
The participants also provided their clinical history and received information about how to rate pain during the medical procedure. Additionally, participants completed post-study questionnaires that rated study belief, realism, and familiarity with their interaction partner. Both groups wore electrodes on their hands and chest to measure physiological arousal.
Although clinicians followed a general script for each interaction, they could use their own clinical style.
Results:
Most participants reported that the simulated interactions felt realistic and that they believed in the study´s purpose, which they were told was “to gain a better understanding of how people respond to pain during medical care”.
Clinician-patient concordance reduced self-reported pain intensity for non-Hispanic Black/African Americans, but not non-Hispanic white patients. In contrast, Hispanic patients with a concordant clinician reported higher pain intensity than those with a discordant clinician, although this did not reach significance.
A racially/ethnically concordant clinician reduced pain-induced physiological arousal, only for Black patients.
Finally, concordance had a stronger influence on pain-induced physiological arousal for those who reported previous experience or concern about racial/ethnic discrimination.
Conclusion:
These findings give the scientific community a better understanding of the socio-cultural factors influencing pain perception and reporting in medical settings. The authors concluded that increasing the number of ethnically diverse physicians could help reduce the persistent disparities in healthcare. See the full text here.