Traditionally, pain has been understood as a purely physical response to things like injuries or nerve damage. But modern research shows that pain is actually influenced by a mix of biological, psychological, and social factors. In other words, our experiences, emotions, and environment all play a role in how we feel pain.
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Studies have found that going through long-term or traumatic stress can make pain more likely to develop and stick around. Pain is also closely linked to mental health struggles like depression and anxiety. Even the way we think and cope with pain can affect how much it hurts; using unhealthy coping strategies can make pain worse and harder to manage.
One main reason stress affects pain is because of how our bodies react when we’re under pressure. When the brain senses stress, it kicks off a chain reaction involving the autonomic nervous system and something called the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is a complex system involving the brain and glands that release hormones like cortisol to help the body handle stress. While this response can be helpful for short-term challenges, if stress becomes constant, the system stays active too long and strains the body.
This can lead to “allostatic overload,” where the body becomes overloaded, causing immune system problems and inflammation in the nervous system. In this state, our bodies become more sensitive to pain, and a vicious cycle begins—stress makes pain worse, and pain adds to stress.
The Racism-Pain Connection
Racism is a system of beliefs and practices that favors some people due to race (generally White people in most Western societies) and disadvantages others (people of color). Racial discrimination means treating someone differently based on assumptions about their race or ethnicity. Research has shown that racial discrimination is a constant source of stress for people of color, harming both their physical and mental health. Most studies on pain have looked at racial differences in treatment, but fewer have explored how discrimination itself impacts pain severity and related challenges.
Although not widely studied, some research does show that stress from discrimination can worsen pain. For example, one study found that regular and major discriminatory experiences were the biggest predictors of back pain among Black participants. For White participants, discrimination had much less impact, with chronic health issues being the main cause of pain. Similar links between discrimination and chronic pain have been found for Asian Americans, particularly Vietnamese and Filipino individuals. Black people have also been found to be more sensitive to pain than non-Hispanic White people, even when factors like income and health are considered. This could be due to the unique stress of discrimination and the different ways racialized groups respond to pain. For example, higher pain sensitivity among Black individuals might be seen as an adaptive social response or even reflect a deeper empathy and awareness of others’ suffering due to their own marginalization.
Unfortunately, while the effects of chronic stress on pain are well-researched, there’s less focus on how stress from discrimination impacts pain for marginalized groups. Understanding this gap is important because it could provide insight into the specific pain experiences faced by these communities.
Pain Undertreated in Communities of Color
In 2020, the world witnessed the tragic and senseless death of Joyce Echaquan—a stark example of how medical biases can turn deadly. A 37-year-old Indigenous Atikamekw woman in Canada and mother of seven, Joyce Echaquan recorded herself on Facebook Live as she endured racist insults and neglect by hospital staff while seeking care for severe stomach pain. Despite her clear signs of distress and history of heart problems, the staff’s biases led them to dismiss her complaints, stereotyping her as a drug addict and sex worker, which ultimately contributed to her death. Her case drew international attention, underscoring the dangers posed by the deep-seated systemic racism that people of color often face in healthcare settings.
Bias can cause a lack of provider empathy and undertreatment of pain.
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This is not an isolated event. Racialized people often experience more severe pain but receive lower-quality healthcare and assessments due to provider biases and systemic racism. A comprehensive review of two decades of research found that Black patients were 22 percent less likely than White patients to receive pain medication. Additionally, White healthcare providers showed less empathy and slower pain responses for Black patients, reflecting unconscious biases. These stereotypes are rooted in false beliefs that Black individuals are less sensitive to pain because of their perceived resilience. Such misconceptions influence how pain is evaluated, especially when there is no visible injury, leading to disparities in treatment.
Chronic Pain Essential Reads
Implicit racial biases and discriminatory practices can have fatal consequences. When healthcare providers operate under stereotypes that diminish the pain of marginalized people, it results in inadequate and sometimes life-threatening care.
All Pain From All Patients Must Be Taken Seriously
Differences in the experience of pain can be rooted in the social and systemic biases that shape our society and medical care. Indifference to the suffering of people from communities of color stems from longstanding stereotypes and implicit biases that devalue their experiences and diminish empathy. People of color should be aware of these healthcare inequities and advocate for themselves when possible, as these systemic issues continue to impact the quality of care they receive. Addressing these injustices is essential for ensuring that marginalized groups receive fair and compassionate treatment.
