Racism as a Source of Pain

This paper addresses a critical health inequity: Black Americans experience disproportionately severe chronic pain compared to White Americans, yet receive less pain screening, referral, and treatment. The authors propose that racism itself—operating at cultural, structural, interpersonal, and individual levels—is an overlooked but preventable source of or exacerbating factor for chronic pain. The paper challenges outdated biomedical models of pain that require tissue pathology and frames pain as a brain-based protective response to threat, including psychosocial threats from discrimination and systemic racism.

The authors employ a predictive processing model of pain, which explains how the brain constructs pain perception from past experiences, current physical and social environments, and threat-related inputs. They synthesize evidence showing that lifetime and daily discrimination experiences, internalized racism, and structural racism (poverty, violence, incarceration) activate the brain's danger-alarm system, triggering or amplifying pain through well-documented neurological pathways. The paper emphasizes that racism-related pain is real and driven by the same brain mechanisms as pain from physical injury.

The authors propose multi-level interventions addressing individual clinical care, healthcare systems, and societal structures. At the clinical level, they recommend that physicians acknowledge historical and contemporary racial injustices, validate patients' pain as real, assess for nociplastic (brain-generated) pain etiologies, and use innovative psychosocial therapies targeting trauma and systemic injustice. Healthcare systems should implement equity-oriented practices, reduce unnecessary invasive interventions, and provide comprehensive training on pain neuroscience and anti-racism. At the societal level, they advocate for movement advocacy, grassroots engagement, cross-sectoral coalitions, and policy reform to dismantle structural racism and improve access to healthcare and social resources.

This framework has significant clinical and public health implications. It provides healthcare providers with evidence-based understanding of why Black Americans report more severe pain and poorer outcomes, enabling more compassionate and effective care. For patients, recognizing racism as a pain source validates their experiences and opens pathways to psychological and social interventions beyond medication and surgery. Broader adoption of this perspective could reduce unnecessary invasive procedures, improve clinical encounters through cultural humility, and contribute to addressing one of the consequences of systemic racism on health equity in America.