The American Medical Association’s Journal of Ethics published the results of a study in 2013 called “Pain and Ethnicity” which highlighted the disparities that patients of color experience when seeking healthcare for their pain. This should come as no surprise to anyone who’s read our series on the differences in the ways that men and women experience pain, which showed that women are more sensitive to pain than men, and yet were treated as though their pain was not as bad. It should come as no surprise that African Americans are also treated differently by their doctors.
African American Patients Experience More (and More Severe) Pain Than White Patients
And yet, even if you were expecting a difference, some of the findings of the study are indeed shocking. The study, which focused on chronic pain (and African Americans with fibromyalgia would surely have been included) found that:
- 27% of African Americans over the age of 50 experience severe pain most of the time (compared with just 17% of white patients)
- African Americans were found to have lower pain thresholds than whites for cold, heat, pressure, and ischemia
- African Americans were more likely than non-Hispanic whites to underreport pain unpleasantness in the clinical setting, especially if the healthcare provider was perceived to be of a higher social status
- African Americans were more likely to attribute pain to personal inadequacies and to use “passive” coping strategies, such as prayer than were non-Hispanic whites
Part of the discrepancies may be due to cultural misconceptions, as African Americans with fibromyalgia may use different language than white patients to describe the intensity and duration of their pain. They may underreport due to a greater stigmatization of pain in their community. Doctors need to be educated in these differences in order to serve the populations they’re treating.
African American Patients are Less Likely to Abuse Opioids but are Less Likely to Have Them Prescribed
Another interesting finding is that African Americans are less likely to abuse opioid pain medication than whites because they were more afraid of becoming addicted. And yet, despite these findings, African American patients are far less likely to have pain treated effectively than white patients. In fact, white patients receive more and better care than African American patients:
- Even when they report higher pain scores, African American patients are less likely to be prescribed pain medication, and when they do receive prescriptions, they are given lower doses than white patients
- African American patients have longer wait times in emergency to receive pain medication than white patients
- African American patients with low back pain reported greater pain and higher levels of disability than whites but were rated by their clinicians as having less severe pain
- African American veterans with osteoarthritis received fewer days’ supply of a nonsteroidal anti-inflammatory drug (NSAID) than white veterans did
What all of these findings point to, the study concludes, is that based on doctors’ misconceptions, African American patients are perceived to be at more likely to abuse prescription pain medication than white patients, when the opposite is true.
You are Your Own Best Advocate When it Comes to Your Healthcare
So, armed with this information, what is an African American patient with fibromyalgia supposed to do? First, it’s good for any patient to make a list of symptoms, severity, duration, and frequency before you go see a doctor. There are some good fibromyalgia questionnaires you can fill out beforehand and take with you (here’s a printable PDF version you can download and take with you to your appointment).
You can also familiarize yourself with the experiences that other patients have had, like Sabrina Dudley Johnson, AKA the fibrocop, who has had pharmacists refuse to fill her prescriptions. The internet is full of great resources, including BlackDoctor.com, which has a section on fibromyalgia.
Finally, don’t be afraid to speak up about your pain and suffering. You are your own best advocate. Fibromyalgia is already an invisible illness, and the taboos around pain and race prevent patients from getting their best care. You know your body better than anyone, so take ownership of it.
What is your experience as a person of color dealing with healthcare providers? Let us know in the comments.
Pain and Ethnicity – AMA Journal of Ethics
African Americans’ Perceptions of Pain and Pain Management – Sage journals
ASK THE EXPERT: IS YOUR CHRONIC PAIN FIBROMYALGIA? – BlackDoctor.org
FibromyalgiaTreating.com Fibro Questionnaire (PDF) – FibromyalgiaTreating.com