“Science and medicine have a long and troubling history of reinforcing racist, anti-ethnic and sexist attitudes and beliefs, as well as ignoring and mistreating marginalised people,” wrote the authors of a paper on pain science (Palermo et al, 2023). “The science of pain is no exception.”

The authors of this quote cite research that highlights ongoing racial misconceptions of heightened pain tolerance among black people. One study they reported on suggested that white medical students had preconceived beliefs that there were biological differences – such as thicker skin – that could account for a higher pain tolerance (Hoffman et al, 2016 ). (It is worth noting that this does not suggest students then went on to treat patients differently.) 

“We have also heard of ‘Asian women syndrome’, that is, [women of south Asian heritage] will bawl at the drop of a hat for anything and everything,” says Dr Roxanne Crosby-Nwaobi, Lead Nurse for Research at Moorfields Eye Hospital, Integrated Clinical Academic Clinical Lecturer at National Institute for Health & Care Research, and Honorary Associate Professor at the Institute of Ophthalmology, University College London. “There are also the social expectations and gender bias in pain perception and expression. This leads to the dismissal and undertreatment of pain in these groups.”

Dr Anna Hood, Psychology Lecturer at the University of Manchester, says that when pain is poorly assessed in patients there is less trust in medical providers: “Patients don’t seek care because not being believed is an ordeal, and they try to fit to what providers want to hear so they can get pain relief. 

“In all my conversations with people living with pain, they tell me of a time when their pain has been disbelieved or ignored by healthcare providers. To make it worse, people do not seek care until they are in their worst pain, and they still may not be believed.”

Research into racial disparities in pain management specifically for eye conditions is limited. One US study found that people from minority backgrounds had worse health outcomes than white patients for dry eye that were not necessarily just the consequence of income and healthcare access (Cui et al, 2022 ).