Pharmacotherapeutic disparities in Pain Treatment Across Ethnicity, Race, and Sex: A Systematic Review

Abstract

Specific Aims: To update a 2010 systematic review by identifying and characterizing pharmacotherapeutic disparities in pain management across race, ethnicity, and sex. Methods: Following PRISMA guidelines, we conducted a systematic review of studies published between 2010 and 2025 using PubMed and Embase. Search terms included MeSH headings related to sex, race/ethnicity, pain, drug therapy, and disparities. Four reviewers screened abstracts and conducted full-text reviews. Eligible studies were English-language, U.S.-based, adult populations evaluating disparities in non-cancer pain treatment. Exclusion criteria included studies not involving pain, focused on hospice/palliative care, or lacking statistical comparisons between at least two demographic groups. Extracted data included study characteristics, demographics, pain type, clinical setting, and pharmacotherapeutic outcomes. Results: Of 61 included articles, 72% reported statistically significant pharmacotherapeutic disparities. The total population studied included 162,456,944 adults across diverse care settings. Most disparities were attributed to race (33%) and ethnicity (21%), with sex-based disparities noted in 10% of studies. The most common disparity involved receipt or non-receipt of treatment (42%), followed by differences in dosing (12%) and time to treatment (1%). Conclusions: Pharmacotherapeutic disparities in pain management persist across healthcare settings, particularly affecting racial and ethnic minorities. Despite increased awareness since 2010, these groups remain more likely to receive fewer or lower doses of analgesics and face longer wait times. Disparities were present in both subjective and objective pain conditions. Addressing clinical decision-making processes and systemic inequities remains critical to improving equitable pain management and reducing the long-term health consequences of untreated or undertreated pain.