Is Your Pain Doctor Woke? Why Cultural Competence Matters for BIPOC

Chronic pain doesn't discriminate and neither should your care but racial disparities exist. If you are a Black or Indigenous Person of Color (BIPOC) here's what you need to know to find a pain doctor who will treat you right. 

Pain is an intensely personal experience, which each of us feels differently. Despite differences in pain experiences, our race, ethnicity, religion, or gender shouldn’t determine our pain care and management.

Unfortunately, when it comes to accessing quality care, getting an accurate assessment, and receiving appropriate treatment, racial disparities do exist and create barriers for many Black, Indigenous, and People of Color (BIPOC).

Effective pain management depends in part on how well the patient and provider communicate. For the best outcome, you and your doctor should be partners, working together. So, before that first doctor visit, it’s important to learn how to successfully communicate your pain.

Here's, a look at how race and ethnicity effects care and what you can do to get better results.

Bias Increases Stress and Causes Poor Health Outcomes

Chronic pain impacts more than 100 million Americans daily and is defined as pain lasting more than 3 months.1 It's also the most common reason people visit doctors.Pain is shaped by multiple elements, including our culture, environment, and our own biological and psychological influences. Unfortunately, studies show patients who are BIPOC do not receive equal treatment when it comes to pain management, and underrepresented women face the biggest barriers in accessing good pain care.3,4 

Illustration of Black family sitting together on a couchBIPOC do not receive the same level of care that White patients do. Healthcare providers need to do more to increase their cultural competency and improve the quality of care for all patients.

Stereotypes and bias are woven throughout the fabric of our society, including within our healthcare systems.5 It’s hard enough for BIPOC to find pain care; racial bias makes this bad problem worse. Studies have also shown healthcare providers have internalized stereotypes (unconscious attitudes or stereotyping that’s also known as implicit bias) and racial prejudice and may find it more difficult to perceive pain in patients who are BIPOC.6 For example, data has shown that White care providers often overlook facial expressions of pain in Black patients compared to White patients.6

These biases, whether conscious or unconscious, impact both the physical and emotional well-being of patients and can cause anxiety, depression, trust issues and worsening of pain. 7,8  According to a report by the Agency for Healthcare Quality and Research (AHRQ) on National Healthcare Disparities, White patients received better care than 41% of Black patients, 37% of Hispanic American patients, 32% of Indigenous patients and 20% of Asian patients. 9

Healthcare providers’ bias and discrimination increases stress, making it harder to access care and results in worsened pain-related experiences for underrepresented patients.10,11

Why It’s Harder for BIPOC to Find Good Pain Care

There are several challenges when it comes to accessing good pain care, including geographic, cultural, language, and economic barriers.12,13,14 The lack of pain doctors in general and the even greater lack of  pain doctors of color, are both factors.15 

Language and cultural barriers exist in many practices lending to an overall lack of cultural competency which can sometimes lead to unrealistic expectations from both patients and providers causing dissatisfaction for both.16.

Misconceptions can create obstacles and lead to incorrect assessment and under-treatment of pain.6 Black, Indigenous, and other people of color report poor quality of care directly linked to their race or ethnicity.17

Salimah Meghani, PhD, with the University of Pennsylvania told PPM “Management of chronic pain is an interactive and continuous process. Experience of pain is proportional to both what you do to manage it  and how you negotiate the treatment of pain with clinicians. Some patients may find it difficult to bring up or discuss their pain concerns with providers."

"In our studies, we have found that Black patients considered factors such as ‘if doctors have to deal with pain they will not concentrate on curing the disease’ or fear that ‘doctors might find it annoying to be told about pain’ in managing their pain. Patients also worry that their pain will not be believed by their providers.” 

Many cultures use complementary medicines and integrative therapies for pain relief, but patients frequently do not disclose this information, fearing disapproval from their pain provider.17,18

This is a dangerous practice since not mentioning the use of complementary and alternative medicines (CAM) can pose risks from interactions with prescription or over the counter medications. Withholding such information also creates trust gaps between providers and patients. Open communication and trust are important when devising pain treatment plans.

Jaime Sanders, patient advocate, and PPM Editorial Advisory Board member is African American and has always been up front about her use of CAM therapies to treat migraine headaches.

“I’m a huge believer in combination therapy for migraine. For me, that includes using herbals, acupressure, and meditation as part of my prevention and acute care  protocols. For a few years, I did not take any medication. Instead I relied on naturopathic medicine as my main source of treatment," she says. “My neurologist and therapists were very supportive of my decision and worked with me to find supplements that helped prevent migraine headaches. Their knowledge informed my decisions and led me to quality products that improved my pain."

Overcoming Cultural Barriers: How to Create a Partnership

Culturally-sensitive pain management means providers are familiar with patients’ ethnocultural beliefs, coping skills, and expectations about pain care. This includes religious views on pain, medication, use of support systems, and pain expression.3 If your provider lacks cultural competency, it’s easy for misunderstandings and bias to control the dialogue rather than your personal pain experience.

Language, both verbal and non-verbal, impacts trust and confidence. Sanders told PPM, “physicians should check inherent biases by becoming more culturally aware when communicating with their patients.” She suggests they acknowledge how culture shapes pain narratives and prompt their patients to discuss pain in non-clinical terms such as “how does it feel for you?”

Sanders says finding your voice and becoming a strong advocate for your care is the first step to overcoming barriers. "You know your pain and how it affects every aspect of your life. Your experiences are valid and are an important part of the patient-provider communication.”

One successful strategy clinicians and health systems can offer is to employ culturally-competent patient navigators and interpreters. They work with patients who have language barriers to improve the care experience. 

Before you select a pain specialist, find out if they make interpreters available–even if you don't need those services yourself it will tell you a lot about the culture of the practice. If the answer is "yes" that's a good sign and indicates you’ve found a provider who understands the importance of cultural context.

How to Talk About Pain So Your Doctor Will Listen

You have the right to be treated with respect, free from bias or discrimination based on your race, ethnicity, gender, religion, sexual orientation, or age. If you feel you aren’t being respected–or your pain isn't being taken seriously–address your concerns with your care provider first.

If you aren’t satisfied with the response, find another provider–one who makes you feel comfortable and confident. Your health is important and getting the best pain management you can improves overall wellbeing.

Consider how your interactions with your healthcare provider make you feel. Does he or she prompt confidence and trust? Do they listen to your concerns? Do you feel it is a partnership or more of a top-down directive?

Dr. Meghani says there are a few things you can do to communicate more effectively with your provider. Here are her top tips:

Be your own advocate. "Recognize that unless you are specifically going to a pain doctor, managing pain is not your health provider’s top priority. Health providers have many competing tasks, so it is important for patients to take a more active role in their pain treatment plan.”

Always be prepared  for your visit. "Take the time to jot down your top pain-related concerns and check out related tools on the American Chronic Pain Association website to help get you organized."

Patient advocate Sanders says being organized and prepared communicates to her doctor that she takes her care seriously. “I have a well-documented history of my treatments (including all medications and CAM treatments, too), procedures, and surgeries, which I can refer, and share, if asked. This also shows my provider that I'm doing all I possibly can be doing to get better."

Frame your pain in terms of function. "Your doctor should know how your unrelieved pain impacts your ability to work, sleep, walk, and complete other daily activities."

Sherra M. Watkins, PhD, clinical psychotherapist, says visuals are vital. "Track your pain. Either use paper and pencil, or an app designed for this purpose. Having a visual allows the physician to see pain trends without you having to remember details like time of day, pain level, location, duration, etc. This is extremely helpful and a good way to build partnerships.” 

Additional Ways to Improve Your Healthcare Experience 

  • If you are interested in learning about complementary or integrative therapies, ask your provider for resources. 
  • Bring a family member or friend along to the appointment to boost your confidence and help you keep track of important information and the points you want to be sure to discuss.
  • Join a chronic pain support group. Can't find something locally? Consider creating one. Reach out to people on Facebook or ask friends/family to share contact information for people they know who might want to get involved in advocacy. There is strength in numbers and advocacy groups, community organizations (including faith-based groups), and other types of support groups can share the work of creating meaningful change for more equitable care for patients who are BIPOC.

Working Toward Cultural Compentency

As you seek better outcomes for yourself and other BIPOC, keep these points and goals in mind: 

  • Encourage inclusivity. Improve cultural competency training and increase awareness of racial disparities by working with healthcare organization and pointing out advantages in working with diverse teams of people. Offer to connect them to  community groups and establish support systems to help educate and correct implicit bias and false stereotypes.
  • Build trust. Eliminate barriers caused by language, literacy, and communication by seeking out and encouraging practices to work with culturally-competent patient navigators.
  • Share resources. Discuss barriers to pain care in economically disadvantaged communities with little or no digital access with local practices. Encourage them to find alternate ways to provide pain care in these areas.
  • Create support groups. Minority-focused chronic pain support groups can be ultilized to provide feedback and help clincians address the cultural aspects of pain.

 

 
Updated on: 09/18/20
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