A growing body of global research shows that patients from minority ethnic backgrounds are less likely to have their pain recognised, believed and adequately treated, with disparities experienced from childhood through end-of-life care. Evidence indicates these disparities persist across emergency care, maternity services, and cancer treatment, with minority patients often required to demonstrate higher pain levels before receiving treatment and receiving less effective care when pain is acknowledged.
Childhood Pain Disparities
A 2024 study by academics at the University of Delaware investigated whether racial bias affects how people perceive children's pain and whether this influences treatment recommendations. Participants viewed computer-generated images of children's faces from different ethnicities showing increasing pain levels. Pain was less readily perceived on black boys' faces compared with white counterparts, requiring stronger expressions of pain before recognition. The authors found strong evidence for racial bias in paediatric pain perception, and participants less likely to perceive pain in black children were also less likely to recommend pain treatment.
A 2020 study led by Monika Goyal of Children's National Hospital in Washington examined racial and ethnic disparities in pain management among children with fractures in US emergency departments. The research found that while minority children were more likely to receive analgesics like paracetamol and ibuprofen, they were less likely to receive 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. "Even after we adjusted for injury severity and pain intensity, minority children were less likely to receive opioids." Another study found black children with appendicitis were 80% less likely to receive opioids for severe pain than white children. A 2024 study from University College London found black children were four times more likely than white children to suffer complications after surgery, including severe pain.
Maternity Care Disparities
The ethnicity pain gap in maternity care is well documented. Guardian research found black women are almost twice as likely to have their births investigated for safety failings compared with white women. Black women remain three times more likely to die during childbirth. An interim report by the National Maternity and Neonatal Investigation included accounts of Asian women being stereotyped as "princesses" and black women as having "tough skin" able to tolerate pain. One woman said: "I feel like, for us black ladies, they feel like we can handle the pain, even when we are complaining we are in pain." Another described being stereotyped as "the angry or aggressive black woman", which affected her care: "I was begging for help … I was made to feel like I was that aggressive, angry black woman. But that isn't me."
A 2025 survey by FiveXMore found 23% of black women did not receive the pain relief they requested during childbirth, and 40% received no explanation. One woman said: "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 found that when black women were not loudly vocalising pain or visibly distressed, healthcare professionals assumed they were managing pain, influenced by stereotypes of black women being naturally strong and resilient.
Emergency Care Disparities
A 2016 study by academics at the University of Boston found black patients were about half as likely to be prescribed opioids in emergency departments compared with white patients. The research, published in Plos One, analysed over 60 million records of pain-related emergency visits from 2007 to 2011 for people aged 18-65. For non-definitive conditions like toothache, abdominal pain, and back pain, black patients were half as likely to receive opioids. Prof Keisha Ray, lead author, said: "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."
Sickle cell disease, which causes excruciating pain episodes and disproportionately affects people of African descent, also shows disparities. In 2021, the Sickle Cell Society published a report finding sufferers experience inadequate care and racism in healthcare settings, particularly in emergency departments where pain is underestimated or dismissed. The report found routine failure to comply with national care standards for pain relief, with some patients having to "battle" for effective pain relief during sickle cell crises.
Chronic Pain Disparities
A study published in March 2026 examining 1,648 US adults with chronic lower back pain found black patients reported more severe and disruptive pain than white counterparts, even after adjusting for socioeconomic and clinical factors. Dr John Licciardone from the University of North Texas Health Science Center said: "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." Another study on chronic pain in Parkinson's patients by King's College London found 83% of white patients received pain relief compared with 48% of black and 43% of Asian patients. For opioids, 43% of white patients received them compared with 4% of black and Asian patients.
Cancer and Palliative Care Disparities
In England, 27-28% of people die from cancer, and the ethnicity pain gap extends to cancer treatment. A major study from the University of Hull found cancer patients from black, South Asian, mixed, and other ethnic backgrounds received fewer opioid prescriptions and lower doses of pain-relieving medications than white patients, even after accounting for age, cancer type, other conditions, and deprivation. Jonathan Koffman, lead researcher and professor of palliative care, said the work was the first population-based study in England to examine the association between ethnicity and opioid prescribing for cancer pain in the last 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. Effective treatment matters not just for comfort, but for dignity, quality of life and even survival. Opioid medicines have proved to be highly effective in managing pain. 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 patients were more likely to have multiple emergency department visits and hospital admissions in their last three months, suggesting undertreated pain in the community.
