Global research reveals persistent racial disparities in pain management, affecting minority patients from childhood through end-of-life care.
Evidence indicates that minority individuals often must demonstrate higher pain levels before receiving attention and frequently receive less effective treatment.
Disparities in Pediatric Pain Management
A 2024 University of Delaware study examined how racial bias affects interpretation of children's pain.
Using computer-generated images of children's faces with varying distress levels, researchers found pain was less readily perceived on Black boys' faces compared to White boys.
Participants required stronger expressions of pain from Black boys before identifying it.
Those less likely to perceive pain in Black children were also less inclined to recommend appropriate treatment.
A 2020 study led by Monika Goyal of Children's National Hospital in Washington analyzed racial disparities among children with long-bone fractures in US emergency departments.
Minority children frequently received non-opioid analgesics like paracetamol and ibuprofen but were less likely to be prescribed opioids.
"When looking at optimal pain reduction, minority children were more likely to be discharged home in significant pain compared with their white counterparts," Dr Goyal said.
The study adjusted for injury severity and pain intensity.
Other pediatric studies confirm the trend.
One investigation found Black children with appendicitis were 80% less likely to receive opioids for severe pain than White children.
A 2024 University College London study found Black children faced four times greater risk of complications after surgery, including severe pain.
Maternal Health and Emergency Care
The ethnicity pain gap is well-documented in maternity services.
Research indicates Black women are almost twice as likely to have their births investigated for safety failings and three times more likely to die during childbirth compared to White women.
An interim report by the National Maternity and Neonatal Investigation detailed cultural stereotyping.
Asian women were sometimes characterized as "princesses" who could not cope with pain, while Black women were stereotyped as having "tough skin" capable of tolerating high pain levels.
During a family evidence panel, one woman stated: "I feel like, for us black ladies, they feel like we can handle the pain, even when we are complaining we are in pain."
Other respondents described being stereotyped as aggressive, negatively impacting their care.
A 2025 survey by FiveXMore found that 23% of Black women did not receive requested pain relief during childbirth, with 40% receiving no explanation for the refusal.
One participant shared: "I asked for pain relief but was told they had no gas and air on my ward despite me seeing others have it.
They gave me a paracetamol and told me I wasn't in labour. My baby was born 10 minutes later."
The survey concluded that when Black women did not vocalize distress loudly, healthcare professionals assumed they were managing, driven by stereotypes about natural resilience.
In emergency care, a 2016 Boston University study published in Plos One analyzed over 60 million pain-related emergency department visits from 2007 to 2011.
For non-definitive conditions like toothaches or abdominal pain, Black patients were about half as likely to receive opioid prescriptions as White patients.
"This study unfortunately tells us what we already know: black patients are improperly treated for pain and that is mostly because of their skin colour," said Prof Keisha Ray, the lead author.
Patients with sickle cell disease, predominantly affecting people of African descent, face similar challenges.
A 2021 Sickle Cell Society report found patients routinely faced inadequate care and underestimated pain in emergency departments.
Disparities extend into chronic pain management.
A March 2026 study of 1,648 US adults with chronic lower back pain revealed Black patients reported more severe and disruptive pain than White patients, even after adjusting for socioeconomic variables.
"Our study aimed to disentangle the effects of race and social disadvantage on outcomes such as pain intensity, disability, and quality of life," said Dr John Licciardone from the University of North Texas Health Science Center.
"These findings are striking because they highlight that racial pain disparities are impacted by sociocultural factors and are not simply the result of genetic or biological differences."
A King's College London study on Parkinson's disease showed 83% of White patients received pain relief compared to 48% of Black and 43% of Asian patients.
The opioid prescription gap was stark: 43% of White patients received them versus just 4% of Black and Asian patients.
In oncology and palliative care, University of Hull research found cancer patients in England from Black, South Asian, mixed, and other ethnic backgrounds received fewer opioid prescriptions and lower doses than White patients, regardless of age or cancer type.
Jonathan Koffman, a professor of palliative care and lead researcher, noted this was the first population-based study in England examining ethnicity and opioid prescribing for cancer pain in the final three months of life.
"Adequate pain relief is a human right. Up to 90% of cancer patients experience pain as they near the end of life," Koffman stated.
"We found that people from minority ethnic backgrounds were less likely to receive prescriptions for opioids compared with those who are white.
Among those prescribed opioids, the doses given were also lower."
The study also found minority ethnic patients experienced more frequent emergency department visits and hospital admissions during their final months, indicating undertreated pain within the community.
