Racial bias in pain perception and response: Experimental examination of automatic and deliberate processes

Vani A. Mathur*, Jennifer A. Richeson, Judith A. Paice, Michael Muzyka, Joan Y. Chiao

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


Racial disparities in pain treatment pose a significant public health and scientific problem. Prior studies have demonstrated that clinicians and nonclinicians are less perceptive of, and suggest less treatment for, the pain of African Americans relative to European Americans. Here we investigate the effects of explicit/implicit patient race presentation, patient race, and perceiver race on pain perception and response. African American and European American participants rated pain perception, empathy, helping motivation, and treatment suggestion in response to vignettes about patients' pain. Vignettes were accompanied by a rapid (implicit) or static (explicit) presentation of an African or European American patient's face. Participants perceived and responded more to European American patients in the implicit prime condition, when the effect of patient race was below the level of conscious regulation. This effect was reversed when patient race was presented explicitly. Additionally, female participants perceived and responded more to the pain of all patients, relative to male participants, and in the implicit prime condition, African American participants were more perceptive and responsive than European Americans to the pain of all patients. Taken together, these results suggest that known disparities in pain treatment may be largely due to automatic (below the level of conscious regulation) rather than deliberate (subject to conscious regulation) biases. These biases were not associated with traditional implicit measures of racial attitudes, suggesting that biases in pain perception and response may be independent of general prejudice. Perspective Results suggest that racial biases in pain perception and treatment are at least partially due to automatic processes. When the relevance of patient race is made explicit, however, biases are attenuated and even reversed. We also find preliminary evidence that African Americans may be more sensitive to the pain of others than are European Americans.

Original languageEnglish (US)
Pages (from-to)476-484
Number of pages9
JournalJournal of Pain
Issue number5
StatePublished - May 2014


  • Racial disparities
  • empathy
  • explicit racial bias
  • implicit racial bias
  • pain

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Anesthesiology and Pain Medicine


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