• See Pain More Clearly Team

Physical attractiveness, gender and other biases in pain judgements

Over the years our team has investigated the impact of stereotypes in judgements of another’s pain. First we studied these phenomena in young people and demonstrated that, everything being equal, patients who are physically attractive are perceived as having less pain than patients who are less physically attractive. This is due to a “what is beautiful is healthy” stereotype. In other words, people tend to perceive physically attractive patients as healthier and, thus, as being less likely to suffer from pain. This stereotype holds irrespective of a patient’s age. Older adult patients, who were deemed to be more physically attractive, were perceived by observers as having less pain than other older patients. This was true even after we ensured that the non-verbal expressions of pain were similar for all patient groups. Patients who are female (compared to male patients) and patients who are older (compared to younger patients) are perceived to have more pain. These differences, based on stereotypes, did not correspond to patients’ actual levels of pain.


We have also shown that characteristics of pain observers are also likely to affect perceptions of pain. For example, health professionals, compared to untrained observers, tend to believe that pain patients experience lower pain intensities. It is important to remember that limited information about the patients was provided to all of our observers in these studies.


However, health professional judgements in real-life clinical situations are less likely to be affected by stereotypes because there tends to be more patient information available (e.g., results of a physical examination).


Nonetheless, our work illustrates that stereotypes can affect the decisions that we make about patients and that there is a need to use more objective indicators of pain than our subjective impressions. This is especially true for patients who have dementia and limited ability to communicate their pain experience. An example of a high quality objective indicator of pain would be the PACSLAC-II, a brief observational tool which we recommend for use in patients with moderate to severe dementia. Guidelines and instructions for using the PACSLAC-II can be found here. Use of standardized approaches to pain assessment, such as the PACSLAC-II, can help minimize the impact of stereotypes that could bias clinical conclusions.


Find out more about evidence-based pain assessment in dementia at seepainmoreclearly.org


- Thomas Hadjistavropoulos, Ph.D.


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Dr. Thomas Hadjistavropoulos- See Pain More Clearly Team Dr. Hadjistavropoulos is an international leader in the area of pain assessment in dementia and has shown leadership in the promotion of the health sciences at the local, national and international level. He is the Research Chair in Aging and Health, Director of the Centre on Aging and Health and Professor of Psychology at the University of Regina, Saskatchewan, Canada. He served as the 2007 President of the Canadian Psychological Association (CPA).

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