From birth until death: how the ethnicity pain gap follows people through life
Patients from minority ethnic backgrounds often have to demonstrate higher levels of pain, only to receive less effective treatment
A growing body of global research has shown that patients from minority ethnic backgrounds are less likely to have their pain recognised, believed and adequately treated – with disparities experienced from childhood all the way through to end-of-life care.
Evidence suggests these disparities persist across multiple healthcare settings, including emergency care, maternity services, and cancer treatment. Study after study from different countries has found that patients from minority ethnic backgrounds are frequently required to demonstrate higher levels of pain before receiving treatment, and are often given less effective treatment even when their pain is acknowledged.
Childhood
Even within childhood, those from minority ethnic backgrounds are likely to experience their pain being minimised, while receiving inadequate treatment compared with their white counterparts.
A 2024 study by academics at the University of Delaware aimed to investigate whether racial bias affects how people see and interpret children’s pain, and whether this may influence how much treatment they believe a child should receive.
The study consisted of participants viewing computer-generated images of children’s faces from different ethnicities showing increasing levels of pain.
Pain was less readily perceived on the faces of black boys compared with their white counterparts, with participants needing to see stronger expressions of pain by black boys before recognising it. The authors argued that their study demonstrated strong evidence for racial bias in paediatric pain perception. Furthermore, participants who were less likely to perceive pain in black children were also less likely to recommend pain treatment for them.
A 2020 study, led by Monika Goyal of the Children’s National Hospital in Washington, took a closer look at apparent racial and ethnic disparities in the management of pain among children presenting to emergency departments across the US with fractures.
The research found there were differences in pain management among children with long-bone fractures from different ethnic backgrounds. Although children from minority ethnic backgrounds 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. “We found that even after we adjusted for injury severity and pain intensity, minority children were less likely to receive opioids for the treatment of their fracture pain.”
Another study found there to be racial differences in pain treatment for children with appendicitis. More specifically, black children were 80% less likely to receive opioids for severe pain than their white counterparts.
These findings were further reinforced by a 2024 study from academics at University College London, who found that black children were at a four times greater risk than white children of suffering complications after surgery, which included experiencing severe pain.
Maternity care
The ethnicity pain gap experienced by women giving birth has been well recorded. Guardian research has found that black women are almost twice as likely to have their births investigated for safety failings compared with their white counterparts.
Black women also remain three times more likely to die during childbirth. An interim report published by the National Maternity and Neonatal Investigation included accounts of Asian women being stereotyped as “princesses”, with the implication that they were overly demanding or unable to cope with pain, while black women were seen as having “tough skin” and able to tolerate pain.
During a family evidence panel, 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.”
The report also heard from black women who described experiences of being stereotyped as “the angry or aggressive black woman”, which in turn affected the care that they received. Another woman told the inquiry: “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 the organisation FiveXMore found that 23% of black women did not receive the pain relief they requested during childbirth, while 40% of these women received no explanation as to why this was the case.
One woman who took part in the survey 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.”
Black women reported that when they were not loudly vocalising their pain or perceived to be visibly distressed, healthcare professionals would assume that they were managing their pain, according to the survey. This perception was influenced by stereotypes of black women being naturally strong and more resilient than women from other groups, the report found.
Emergency care
A 2016 study by academics at the University of Boston found that black patients were about half as likely to be prescribed opioid medicines in the emergency department than their white counterparts.
The research, published in the journal Plos One, looked at more than 60m records of pain-related emergency department visits from 2007 to 2011 for people aged 18 to 65. When looking at non-definitive conditions such as toothache, abdominal pain and back pain, black patients were half as likely to be prescribed opioids compared with their white counterparts.
“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, lead author of the report.
Sickle cell disease is a name for a group of inherited health conditions that can cause excruciatingly painful episodes, and is significantly more likely to affect people of African descent.
In 2021, the Sickle Cell Society charity published a report that found sufferers were likely to experience inadequate care and racism in healthcare settings, particularly in emergency departments where pain is underestimated or dismissed. The report found there was a routine failure to comply with national care standards or Nice standards for pain relief when patients attend emergency departments, and some had to “battle” for effective pain relief whenever they attended emergency departments due to a sickle cell crisis.
Chronic pain
The chronic pain caused by sickle cell isn’t the only area where black patients face worse health outcomes. A study published in March 2026 by academics, which looked at a sample of 1,648 US adults with chronic lower back pain, found that black patients reported more severe and disruptive chronic pain compared with their white counterparts. Even after adjusting for socioeconomic and clinical factors, black patients still had higher pain levels overall.
“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,” he added.
Another study looking specifically at chronic pain among patients with Parkinson’s by academics at King’s College London found 83% of white patients received pain relief compared with 48% of black and 43% of Asian patients.
This disparity was most evident within opioids, with 43% of white patients receiving this type of pain relief compared with 4% of black and Asian patients.
Cancer and palliative care
In England, 27% to 28% of people will die from cancer – and research suggests the ethnicity pain gap is also felt during treatment for the disease.
A major study from researchers at 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 people from white backgrounds, even after accounting for patient age, cancer type, other health conditions and levels of deprivation.
Jonathan Koffman, the lead researcher of the study and a 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.”
Patients from minority ethnic backgrounds were more likely to have multiple emergency department visits and multiple hospital admissions in their last three months of life, the study found, suggesting their pain may be undertreated in the community.