Bias, Stigma, and Social Determinants of Health

Disparate medical care often adds significant burdens and challenges for patients in need, including those who are vulnerable and suffering with pain. Numerous reports have demonstrated differences in the delivery of pain assessment and treatment based on factors such as race, ethnicity, and social determinants of health. While it is well known that pain can often be a unique experience for individuals based on biological, cultural, and psychosocial factors, unfortunately bias, stigmatization, and stereotyping may often play a role in the pain care they receive. This chapter details how racial and ethnic biases have the potential to play a significant role in fueling disparity in pain treatment not only in adult patient populations, but in pediatric patients as well. The negative impact which biases can have in pain assessment and treatment is discussed, including deficiencies in treatment plan formulation, lower levels of clinician empathy, and a lower likelihood of successful treatment outcomes. This chapter also discusses how gender-based biases have the potential to negatively affect pain care. An in-depth analysis of the role of stigma in further promoting inequities in pain care is described in detail, from the perspectives of the patient, clinician, and society at large. Additionally, this chapter explores how social determinants of health can be significant contributors to health disparity and inequitable delivery of pain care, particularly with respect to decreased overall quality of life, diminished level of function, and poorer treatment outcomes. Suggested strategies are described to help mitigate the negative impact of bias, stigma, and social determinants on pain care, with the intention of providing more compassionate, equitable, and successful treatment outcomes.