Providers may have a race- and gender-based implicit bias regarding the level of pain tolerance in pediatric patients with chronic abdominal pain, according to study results published in the Journal of Pain.

In this study, the Virtual Human methodology and a pain-related version of the Implicit Association Test (IAT) were used to evaluate the effects of patient race/gender on the assessment by and treatment decisions of 129 medical students or providers of pediatric chronic abdominal pain.

Providers were found to rate black patients as more distressed (mean difference [MD], 2.33±0.71; 95% CI, 0.92-3.73; P <.01) and as experiencing more pain-related interference (MD, 3.14±0.76; 95% CI, 1.63-4.64; P <.01) compared with white patients.

Providers were found to be more likely to prescribe opioids to black vs white patients (MD, 2.41±0.58; 95% CI, 1.05-3.76; P <.01) and to perceive girls as more distressed by pain compared with boys (MD, 2.41±0.79; 95% CI, 0.58 to 3.70; P <.01). Treatment recommendations were not found to change based on gender.

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Providers were found to perceive black patients and boys as having higher pain tolerance compared with their demographic counterparts. These implicit attitudes were not found to affect pain assessment or treatment decisions.

“Assessing providers’ attentional biases and if they vary by patient demographics may provide a clearer picture of what contextual information contributes most to biased decision-making,” noted the researchers. “Identifying these differences can lead to targeted interventions to reduce inequalities in the pediatric pain experience.”

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Reference

Miller MM, Williams AE, Zapolski TCB, et al. Assessment and treatment recommendations for pediatric pain: the influence of patient race, patient gender, and provider pain-related attitudes [published online July 27, 2019]. J Pain. doi:10.1016/j.jpain.2019.07.002