Pain Assessment

Reflecting on Your Own Biases

Everyone has biases, meaning preconceived notions about something (such as pain) or someone. Biases can be related to race/ethnicity, gender/sex, age, and medical conditions, and they can develop as a result of various factors including culture, personal experiences, and popular media.

When we first see a client, we tend to make assumptions about the presence and even the severity of pain based on cues that are readily available to us (e.g., facial expression, body positioning, vocalizations) (Riva et al., 2011). These assumptions are rooted in our biases regarding what pain looks and even sounds like. These biases may emerge from our own personal experiences. Our initial impressions of a client’s pain can form what is called an “anchor” or have an “anchor effect” in which all additional assessments of the client’s pain are influenced by these initial impressions (Riva et al., 2011). These assumptions can also be based on racist ideas (discussed further in the next section) or on ageist ideas, for example that older people or newborns do not feel pain. Another biased assumption is that people living with cognitive impairment (such as dementia) do not feel pain in the same way as others because they may have difficulty articulating that pain. These assumptions can mean that pain is underassessed and undertreated in certain populations.

It is also very important to be aware that some people may openly talk about their pain and cry out in agony, while others may be stoic and hide their pain. Some people may stay home in bed when they are in pain while others may continue with their daily life and go to work.

Unexplored biases can have a strong influence on pain assessment. This is particularly important considering that healthcare professionals have been found to underestimate pain in comparison with the client’s own self-report (Seers et al., 2018). As such, it is vital that you constantly reflect upon and explore your biases related to pain and pain assessment.

For example, try to explore your own inherent biases related to what pain looks like by reflecting on the following questions:

  • How would someone know that you are in pain?
  • Could they tell by your facial expression or body position?
  • What behaviours would you display if you were in pain? Would you be quiet, grimacing, or smiling? Would you isolate yourself? Would you be trying to sleep, walk around, or talk to others?
  • Would you tell someone you were in pain or keep it to yourself? How bad would the pain have to be for you to be concerned or for you to tell someone?
  • Would you exaggerate or minimize the level of pain (or pain of a family member) when describing it to a healthcare provider due to fear of discrimination?

Your answers to these questions form part of your cultural bias. If you are not aware of your cultural biases, you may judge the validity of another person’s pain based on your own answers. Ultimately, a person’s pain should be acknowledged, respected, and acted upon (RNAO, 2013). 

What we might leave you with is: although your own personal experiences inform your biases, these experiences may also provide you insight into a client’s pain.


Riva, P., Rusconi, P., & Montali, L. (2011). The influence of anchoring on pain judgment. Journal of Pain and Symptom Management, 42(2), 265-277.

RNAO (2013). Assessment and management of pain. 3rd edition.

Seers, T., Derry, S., Seers, K., & Moore, R. (2018). Professionals underestimate patients’ pain: Comprehensive review. Pain, 159(5), 811-818.


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