Racial and ethnic disparities in pain management in the United States

Purpose: To critically examine research on racial and ethnic disparities in pain management with a focus on who has been studied, the magnitude of disparities, and potential explanations for those disparities. Design: A systematic literature review. Articles included were reports of original research in which at least two racial or ethnic groups were compared on adequacy of pain management. Methods: Review of research articles published between 1990 and 2004 with the primary aim of identifying the influence of race or ethnicity on pain management in the US. Databases were CINAHL, Medline, and Pubmed. Relevant articles were categorized by pain type. Effect sizes were calculated where sufficient data were provided. Findings: Studies were focused on Blacks or African Americans, Whites or non-Hispanic Whites, Hispanics, and Asians. Terms for describing these groups were neither well defined nor consistently used within and across studies. Disparities in pain management were reported in relation to minority status, but the magnitudes of these disparities were mostly small. Conclusions: Greater clarity and consistency are needed in the use of the terms race, ethnicity, and minority. Groups were treated as if they were homogeneous, and details were lacking about whether subgroups of different races or ethnicities had been studied. Although reported disparities in pain management were small, they were consistent. Further research is needed to examine differences within groups and to explain possible reasons for disparities across groups.