Half the white medical trainees in one study endorsed false beliefs about pain

In a study published in PNAS, half of a sample of white medical students and residents endorsed false beliefs about biological differences between Black and white people — statements such as Black people's skin being thicker than white people's [s1]. Those who endorsed them rated a Black patient's pain as lower than a white patient's and made less accurate treatment recommendations [s1]. Those who did not endorse them rated the Black patient's pain as higher, and showed no bias in what they recommended [s1].

That experiment is the most-cited single piece of evidence in a literature that is now large, consistent in direction, and considerably messier in its details than the headline suggests.

The experiment

The paper reports two studies. The first documented the false beliefs among white laypersons and found that participants who more strongly endorsed them reported lower pain ratings for a Black target than a white one [s1]. The second extended the design into a medical context with white medical students and residents, and produced the split described above: endorsement predicted both lower pain assessment and less accurate treatment recommendation, and non-endorsement predicted neither [s1].

The paper's framing sentence is the one worth quoting in full context: Black Americans are systematically undertreated for pain relative to white Americans, and the study examines whether that bias is related to these false beliefs [s1]. It is an experiment on belief and judgement, not a measurement of what happens in clinics — which is what the observational work supplies.

What happens in clinics

A review of racial and ethnic inequities in paediatric pain management across emergency care settings finds that children from minoritised racial and ethnic groups are less likely to receive analgesia, including opioids, and less likely to experience pain relief — a pattern the field calls oligoanalgesia [s2]. It also notes, honestly, that the evidence on disparities in discharge prescribing is mixed [s2].

Among older cancer survivors the pattern shows up in claims data. A SEER-Medicare analysis of 300,048 people aged 66 or older diagnosed with cancer between 2007 and 2016 — 72.9% non-Hispanic White, 9.6% non-Hispanic Black, 8.8% Hispanic-Latino, 7.3% Asian/Pacific Islander, 1.4% other — measured pain treatment within 90 days of diagnosis [s3]. Compared with non-Hispanic White patients, non-Hispanic Black patients (adjusted incidence ratio 0.96, 95% CI 0.95–0.98), Asian/Pacific Islander patients (0.96, 0.95–0.98) and the "other" group (0.91, 0.87–0.94) received less pain treatment overall [s3].

The gap was widest for non-pharmacological treatment, used less by non-Hispanic Black (aIR 0.65, 0.62–0.69) and Hispanic-Latino survivors (0.69, 0.65–0.73) [s3]. Opioids made up 80% of treatments [s3]. And the pattern within treatment was different from the pattern of access: minority survivors received lower opioid doses for longer durations, and higher non-opioid doses for shorter durations [s3].

The complication

The picture gets harder to read once opioids are separated out. A cross-sectional study of 19,919 patients diagnosed with chronic non-cancer pain at a major US academic medical centre between 1 July 2020 and 1 July 2022 found that non-Hispanic Black and Hispanic patients had lower odds of interventional pain referrals (OR 0.72 and 0.40) and neurosurgical referrals (0.66 and 0.49) than non-Hispanic White patients — but higher odds of orthopaedic surgery (1.40) and physical therapy referrals (1.16) among non-Hispanic Black patients [s4]. Both groups also had lower odds of opioid therapy: 0.75 and 0.47 [s4].

Lower opioid prescribing is not automatically undertreatment. During a period in which reducing opioid prescribing was an explicit policy goal, a lower rate could reflect more conservative — even safer — care. But it sits alongside lower referral rates to specialist pain services in the same dataset [s4], which is harder to read as caution. And the direction runs opposite to the paediatric emergency finding, where minoritised children were less likely to receive analgesia and less likely to get relief [s2].

The honest summary is that access to pain services is consistently lower and the interpretation of the drug-specific numbers is contested.

Beyond race

The literature extends to other axes, with varying evidential strength. An analysis of pain during childbirth in a large hospital system covering 46,671 births reported racial and ethnic differences in the frequency of pain assessments, in recorded pain ratings, and in whether pharmacological or non-pharmacological treatment was delivered [s5]. The authors' framing is that pain during labour can be symptomatic of maternal morbidity as well as an independent predictor of adverse postpartum outcomes, which is why measurement gaps matter beyond comfort [s5].

What the evidence supports doing about it

Less than the volume of publication implies. The paediatric review is explicit that identifying disparities is only a first step, and that progress requires understanding root causes and implementing multifactorial interventions [s2]. Its candidate strategies are standardising clinical processes to reduce variability, using equity-informed pain assessment tools and guidelines, centring patient and family lived experience, applying quality improvement methods, and re-examining clinician education to mitigate bias [s2].

Standardisation is the mechanism with the clearest logic behind it. Bias operates in discretion; a protocol that specifies who gets assessed, how, and what follows from a given score narrows the space in which a clinician's judgement about how much a patient is hurting can diverge by patient group. Whether that works in practice is an empirical question that the reviewed literature has largely not yet answered.

What to watch

Whether any of the equity-focused interventions produce measured reductions in the gaps rather than further measurements of them. The descriptive literature is now extensive and consistent [s2] [s3] [s4] [s5]; the intervention literature is not.

This article is informational and is not medical advice.

Sources

• Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites — Proceedings of the National Academy of Sciences, 2016-04-04
• Addressing Racial and Ethnic Inequities in Pediatric Pain Management in Emergent Settings — Pediatrics, 2026-06-17
• Racial and Ethnic Disparities in Pharmacologic and Non-Pharmacologic Pain Management Among Older Cancer Survivors — Cancer Medicine, 2026-01-23
• Exploring Racial Disparities in Chronic Pain Management — Journal of Pain Research, 2025-06-09
• Disparities in Pain Evaluation and Treatment During Labor: A Racial and Ethnic Perspective — Journal of Clinical Medicine, 2025-04-30