Background: Evidence suggests that racial and ethnic disparities exist in access to effective
pain treatment.
Purpose: To review evidence of these disparities and provide recommendations for care and
further research.
Design: Systematic review
Methods: We conducted a MEDLINE search using the MeSH terms of ethnic groups, minority
groups, pain, analgesia, and analgesics. We included studies describing current practice
patterns, utilization of available treatments, treatment outcomes, and patient and provider
knowledge, attitudes, and behaviors.
Results: Our search identified 35 journal articles describing the effect of patient race and
ethnicity on pain assessment and management. Three studies on pain assessment revealed
that minority patients are more likely to have their pain underestimated by providers and
less likely to have pain scores documented in the medical record compared to whites. Eleven
of 17 studies found that African Americans and Hispanics are less likely to receive opioid
analgesics and more likely to have their pain untreated compared to white patients. Three
studies revealed that minority patients are more likely to have negative pain management index
(PMI) scores—undertreated pain—compared to whites. Patient-related, provider-related,
and pharmacy-related barriers to effective pain management were identified.
Conclusion: The majority of studies reveal racial and ethnic disparities in access to effective
pain treatment akin to disparities found in other medical services. Quality improvement
initiatives that improve treatment of pain for all patients according to established guidelines
should decrease disparities by race or ethnicity. Educational interventions should aim to improve
patient-provider communication regarding pain and its treatment and should provide
support around substance abuse issues. Further research is needed to examine pain treatment
outcomes and to determine whether health care system factors lead to these disparities.
