Disparities associated with race and ethnicity in pain management: a scoping review.

Abstract

Introduction: Health inequalities can occur where there are differences in how people are treated with respect to their race and ethnicity. Disparities and systemic inequities in healthcare have led to negative outcomes. Pain management is an area where there are perceived health inequalities. Medicines optimisation is a framework for healthcare provider interventions under four principles to ensure that medicines are used safely and effectively, producing the best possible outcomes for patients. Using this framework allows a systematic and theory-informed identification of areas of care at risk of disparities.

Aim: The aim was to assess disparities associated with race and ethnicity in pain management, mapped to the medicines optimisation framework.

Method: Electronic databases CINAHL, Ovid and Medline were searched from 2012 to 2025. Studies involving pain management, medicine optimisation, ethnicity, ethnic minorities and race were included. Two reviewers independently screened titles, abstracts and full texts. Data were extracted on evidence relating to the application of the four principles of medicines optimisation, and for the presence or absence of disparities in pain management overall.

Results: One hundred and eighteen studies were identified that met the inclusion criteria. Eighty-nine (75%) identified pain management disparities in respect to race and ethnicity, with the majority of disparities related to medicine optimisation principle 2 (evidenced based medicine). Disparities identified were discrepancies in the reporting of pain scores, time to pain and pain assessment and discrepancies in the receipt of opioids across all races. Other disparities were, inconsistencies with prescriptions issued at discharge or outpatients, patients' dissatisfaction with pain management. There were less disparities observed in studies that involved children, when managing surgical pain and pain in palliative care and when protocols were used in the management of pain.

Conclusion: Disparities in pain management associated with patient race and ethnicity are prevalent have decreased over the past decade. Healthcare professionals should seek to understand the patient experience and incorporate protocols/guidelines into their care to promote evidence-based medicine. Further research in wider geographies is required, particularly in medication safety and incorporating medicines optimisation into routine care.