How Race and Gender Shape Who Gets Pain Relief

A woman goes in for an IUD insertion and is told the pain will be brief, maybe a pinch. Nearly forty percent of clinics offering the procedure provide no anesthesia at all, even though most women report moderate to severe pain during it. A Black patient arrives at the emergency room with a broken bone and waits longer for pain medication than a white patient with the same injury, and when he does receive something, it's often a lower dose. These aren't isolated stories. They're patterns that researchers have documented for decades, and they point to something uncomfortable about how modern medicine decides whose pain is real and whose can wait.

Pain is subjective by nature. There's no blood test for it, no imaging scan that measures suffering directly. Clinicians rely on what patients tell them, combined with their own judgment about how much to trust that report. That judgment, it turns out, is not applied evenly.

Research on racial disparities in pain treatment tells a consistent story. Black patients are less likely to receive pain medication than white patients reporting the same level of pain, and when they do receive it, the doses tend to be lower. This holds across settings, from emergency rooms treating fractures to nursing homes caring for the elderly, where Black residents have been found to have a much higher chance of receiving no pain treatment at all compared to white residents. It even holds among children. One study on pediatric appendicitis found that Black kids received opioid pain relief far less often than white kids despite comparable pain scores.

The reason isn't a matter of policy or explicit prejudice, at least not in most cases. Researchers have traced part of it to false beliefs about biology that persist even among people with medical training. In one striking study, medical students and residents who endorsed myths like the idea that Black people have thicker skin or less sensitive nerve endings rated Black patients' pain as lower and recommended less aggressive treatment for it. These beliefs have no basis in fact, but they shape decisions anyway, often without the person making them realizing it. Other research has found that people are simply slower to recognize pain on Black faces than on white ones, suggesting the bias can operate before a clinician even reaches the point of forming a judgment.

Gender follows a similar arc, though the mechanism looks a little different. The pattern has a name in the literature, the Yentl syndrome, coined to describe how women's symptoms get dismissed or misread unless they closely resemble how a disease presents in men. It started as an observation about heart disease, where women having a heart attack often don't get the classic chest pain associated with men and are diagnosed later as a result. But it extends into pain treatment broadly. Women are more likely than men to have their pain attributed to psychological causes, and studies have shown physicians reach for antidepressants over analgesics for female patients more often, as though the pain must be in her head rather than her body. In emergency departments, women wait longer for pain medication than men even when they report the same pain intensity, and nurses have been found to record women's pain scores less often than men's altogether.

What ties these two patterns together isn't just that both groups are undertreated. It's that both disparities come from the same underlying failure, which is a system that quietly discounts a patient's own account of their pain in favor of assumptions about the group they belong to. And for patients who sit at the intersection of both, Black women in particular, the effect isn't just additive. It compounds, showing up starkly in maternal health outcomes where Black women are far more likely to have their pain and symptoms dismissed during childbirth, sometimes with fatal consequences.

None of this suggests that clinicians are acting in bad faith. Most of the bias documented in this research is implicit, operating below conscious awareness, which is part of why it has proven so hard to correct. Medical schools have begun incorporating implicit bias training, and some hospitals have revised pain assessment protocols to rely less on subjective clinician judgment. But the deeper fix will need to come from clinical research itself, which has historically underrepresented both women and people of color in the trials that shape treatment guidelines in the first place.

Go back to that woman in the exam room, or the man in the ER with a broken bone. Neither of them is asking for anything unusual. They're asking to be believed. That such a basic request remains unevenly granted, depending on who is asking, says less about the patients than it does about the system meant to care for them.

Written By: Tarleen Chhatwal

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Sources

AAMC. (2023, June 5). How we fail black patients in pain. Association of American Medical Colleges. https://www.aamc.org/news/how-we-fail-black-patients-pain

Batten School of Leadership and Public Policy. (2020, June 30). Black Americans are systematically under-treated for pain. Why? University of Virginia. https://batten.virginia.edu/about/news/black-americans-are-systematically-under-treated-pain-why

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). 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, 113(16), 4296–4301. https://doi.org/10.1073/pnas.1516047113

Meghani, S. H., & colleagues. (2009). Racial and ethnic disparities in pain: Causes and consequences of unequal care. The Journal of Pain, 10(12), 1187–1204. https://www.jpain.org/article/S1526-5900(09)00775-5/fulltext

Practical Pain Management. (2020, October 1). Special report: Race, pain management, and the system. https://www.practicalpainmanagement.com/resources/practice-management/special-report-race-pain-management-system

Public Health Review. (2023, November 8). Women in a man's world: A review of the discrimination women face in health care. Public Health Review. https://www.pghr.org/post/women-in-a-man-s-world-a-review-of-the-discrimination-women-face-in-health-care

Wikipedia contributors. (n.d.). Yentl syndrome. Wikipedia. Retrieved July 24, 2026, from https://en.wikipedia.org/wiki/Yentl_syndrome

Wildcat, A. (n.d.). Opinion: The gender pain gap in medicine is a scientific failure. The Arizona Wildcat. https://wildcat.arizona.edu/163175/opinions/opinion-the-gender-pain-gap-in-medicine-is-a-scientific-failure/