PAIN MEDICINE Volume 4 • Number 3 • 2003 REVIEW ARTICLE The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain Carmen R. Green, MD, a Karen O. Anderson, PhD, b Tamara A. Baker, PhD, c Lisa C. Campbell, PhD, d Sheila Decker, PhD, e Roger B. Fillingim, PhD, f Donna A. Kaloukalani, MD, MPH, g Kathyrn E. Lasch, PhD, h Cynthia Myers, PhD, i Raymond C. Tait, PhD, j Knox H. Todd, MD, MPH, k and April H. Vallerand, PhD, RN l a University of Michigan Medical School, Ann Arbor, Michigan; b M.D. Anderson Cancer Center Pain Research Group, Houston, Texas; c University of Michigan, School of Public Health, Ann Arbor, Michigan; d Duke University Medical Center, Durham, North Carolina; e University of Iowa School of Nursing, Iowa City, Iowa; f University of Florida College of Dentistry, Gainesville, Florida; g Washington University, St. Louis, Missouri; h New England Medical Center, Boston, Massachusetts; i University of California Los Angeles, Los Angeles, California; j St. Louis University School of Medicine, St. Louis, Missouri; k Emory University, Rollins School of Public Health, Atlanta, Georgia; and l Wayne State University College of Nursing, Detroit, Michigan ABSTRACT Context. Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minori- ties tend to be undertreated for pain when compared with non-Hispanic Whites. Objectives. To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain per- ception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency depart- ment). Pertinent literature on patient, health care provider, and health care system factors that con- tribute to racial and ethnic disparities in pain treatment are provided. Evidence. A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expert- ise. Scientific evidence was given precedence over anecdotal experience. The abstracts were com- piled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication. Conclusions. Consistent with the Institute of Medicine’s report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., post- operative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educa- tional interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities. © American Academy of Pain Medicine 1526-2375/03/$15.00/277 277–294 Reprint requests to: Carmen R. Green, MD, University of Michigan Medical School, Department of Anesthesiology, 1500 East Medical Center Drive, 1H247 UH—Box 0048, Ann Arbor, Michigan 48109. Tel: (734) 936-4240; Fax: (734) 936- 9091; E-mail: carmeng@umich.edu.