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Although pain care decisions unfold as a negotiation between patients and surgeons, previous research has identified patient-level and provider-level factors contributing to racial disparities in surgical pain care in isolation. We call for changes in the investigations of such racial disparities at the levels of conceptualization, research design, analysis, and research team composition.

A growing body of evidence demonstrates that perceivers recognize painful expressions less readily on Black (compared to white) faces. However, it is unclear whether this bias occurs independent of controlled processing (for example, the deliberate engagement of racial stereotypes) and whether this bias is still observed when other diagnostic information (e.g., self-reported pain experience) is available. Across five experiments we examined the speed, spontaneity, and robustness of racial bias in pain perception. First, we observed that racial bias in pain perception was still evident under minimal presentation conditions (as brief as 33ms) and was most apparent for ambiguous (versus high intensity) pain expressions (Exp. 1). Next, we manipulated the amount of cognitive load participants were under while viewing and rating Black and white faces in varying degrees of pain (Exps. 2A-B). Here, we observed that perceivers had more stringent thresholds for seeing pain on Black (versus white) faces regardless of whether participants were under high (versus low) load. Finally, we examined whether this bias would persist when participants were also provided with other information regarding targets’ pain – specifically, self-reported pain experience (Exps. 3A-B). While self-report information reduced perceivers’ thresholds for seeing pain overall, racial bias in pain perception was not reliably moderated by self-reported pain experience. Together, these data demonstrate that racial bias in pain perception occurs automatically, based on minimal visual input, and above and beyond other diagnostic information.

Racial disparities in pain care may stem, in part, from a perceptual source. While perceptual disruptions in recognizing painful expressions on Black faces have been demonstrated under tightly-controlled conditions (e.g., controlling for low-level stimulus differences in luminance and facial structure, using all male stimuli), these effects may be exacerbated by cues to racial prototypicality. Indeed, both bottom-up (e.g., skin tone, facial structure) and top-down (e.g., stereotype associations between race and gender) factors related to racial prototypicality moderate social perception, with some evidence pointing towards deleterious consequences in the domain of health. Here, we assessed whether these factors shape racial bias in pain perception: we examined the effect of racially prototypical features in Experiments 1 and 2 and target gender in a meta-analysis across five additional experiments. Overall, darker skin tones were associated with more stringent pain perception and more conservative treatment, while racially prototypic structural features exacerbated racial bias in pain outcomes. Moreover, target gender reliably moderated the effect of race on pain outcomes: racial biases in both pain perception and treatment were larger for male (versus female) targets. Taken together, these data demonstrate the overall robustness of racial bias in pain perception and its facilitation of gaps in treatment, but also the extent to which these biases are moderated by both bottom-up and top-down factors related to racial prototypicality.

Racial disparities in pain care may be linked to a perceptual source: perceivers see pain less readily on Black (versus white) faces. We conducted an internal meta-analysis (40 studies; N=6252) to assess the generalizability, robustness, and psychological bases of this phenomenon. Meta-analysis strongly confirmed race-based gaps in pain perception and treatment. Moreover, bias in perception consistently facilitated bias in treatment. These effects were robust to differences in stimuli, samples, and perceiver gender and race. Notably, both Black and white perceivers showed a tendency to see pain less readily on Black faces, suggesting this bias is not merely a consequence of group membership. Further, increased dehumanization of and decreased intergroup contact with Black individuals was associated with racial bias in pain perception and treatment, though these effects were small. These results demonstrate the robustness of perceptual contributions to racial pain disparities and shed light on potential targets for future intervention.

Racial disparities in pain care may stem, in part, from perceptual roots. It remains unresolved, however, whether this perceptual gap is driven by general deficits in intergroup emotion recognition, endorsement of specific racial stereotypes, or an interaction between the two. We conducted four experiments (total N = 635) assessing relationships between biases in pain perception and treatment and biases in the perception of anger, happiness, fear, and sadness. Participants saw Black and White male targets making increasingly painful and angry (Experiment 1), happy (Experiment 2), fearful (Experiment 3), or sad expressions (Experiment 4). The effect of target race consistently varied based on the emotion displayed. Participants repeatedly saw pain more readily on White (vs. Black) male faces. However, while participants also saw sadness less readily on Black faces, perception of anger, fear, and happiness did not vary by target race. Moreover, the tendency to see pain less readily on Black faces predicted similar differences in recognizing (particularly negative) expressions, though only racial bias in pain perception facilitated similar biases in treatment. Finally, while endorsement of racialized threat stereotypes facilitated recognition of angry expressions and was marginally associated with impeded recognition of happy expressions on Black faces, gaps in pain perception were not reliably related to stereotype endorsement. These data suggest that while racial bias in pain perception is associated with a general bias in recognizing negative emotion on Black male faces, the effects of target race on pain perception are particularly robust and have distinct consequences for gaps in treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Humans are highly attuned to perceptual cues about their values. A growing body of evidence suggests that people selectively attend to moral stimuli. However, it is unknown whether morality is prioritized early in perception or much later in cognitive processing. We use a combination of behavioral methods and electroencephalography to investigate how early in perception moral words are prioritized relative to non-moral words. The behavioral data replicate previous research indicating that people are more likely to correctly identify moral than non-moral words in a modified lexical decision task. The electroencephalography data reveal that words are distinguished from non-words as early as 200 milliseconds after onset over frontal brain areas, and moral words are distinguished from non-moral words 100 milliseconds later over left-posterior cortex. Further analyses reveal that differences in brain activity to moral vs. non-moral words cannot be explained by differences in arousal associated with the words. These results suggest that moral content might be prioritized in conscious awareness after an initial perceptual encoding but before subsequent memory processing or action preparation. This work offers a more precise theoretical framework for understanding how morality impacts vision and behavior.