Making Justice Real

The Official Blog of the Legal Aid Society of the District of Columbia

Race, Pain Treatment, and Social Security Claims

A New York Times article from earlier this week sheds light on racial disparities in how pain is treated, finding that minorities, and particularly African Americans, frequently receive less effective treatment for acute and chronic pain than whites.  The article points to numerous factors contributing to the disparity, such as inadequately stocked pharmacies in predominately African-American neighborhoods, and less insurance coverage in African-American communities.  But it also specifically addresses the role that racial stereotypes play in causing the disparity in effective pain treatment.  One pain researcher from St. Louis University states that “we believe negative stereotypes impact clinical decision-making.”

A particular stereotype – the perception that African Americans are more likely to abuse powerful pain drugs like opioids than whites – may play a key role in the disparity.  It turns out there may be no truth whatsoever to that assumption.  According to a 2013 article in the AMA’s Journal of Ethics by Dr. Ronald Wyatt, non-Hispanic whites are in fact more likely to abuse opioids as well as suffer drug-related deaths from opioids than other racial groups.  Dr. Wyatt’s article also discussed how these disparities in access to effective pain management impacts African Americans in multiple health settings.  African Americans are more likely to wait longer for pain medication in emergency rooms, less likely to have their pain needs in hospice settings met than whites, and receive lower doses of pain medications despite higher pain scores.  Furthermore, African-American veterans with osteoarthritis were prescribed anti-inflammatory medicine for a period covering fewer days than white veterans.

It is easy to see how this disparity can impact people, even outside the context of their immediate health needs.  For example, in Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) cases, pain is a key factor that must be weighed when determining whether a claimant is disabled.  Claimants and their advocates rely on physician opinions and records to support their testimony about the pain claimant’s experience and its impact on their lives.  However, these opinions and records could also be infected with racial bias in some cases.  The New York Times article notes that only 4 percent of practicing physicians in the United States are African American, and that physicians may have a tendency “to empathize less with patients whose race is different from their own — perhaps subconsciously — and to underestimate the severity of their pain.”  If a claimant’s treating physician adopts these stereotypes when writing medical records and prescribing treatment for pain, the result will likely be records and treatments that do not accurately describe the claimant’s medical conditions.  Thus, an Administrative Law Judge (ALJ) could find an African-American claimant’s testimony about pain less credible, making it harder for such claimants to prove their disability case to Social Security.

Just as the New York Times article contains important information for the medical community, the legal community as well as government agencies should take note as well of its conclusions.  Social Security should ensure that its ALJ’s are aware of the biases that African Americans can experience in the medical community when they make their determinations of credibility and disability.  And advocates must prepare their cases with such biases in mind.

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