Over 50 years of research on social disparities in pain and pain treatment: a scoping review of reviews

Abstract

Research on social disparities in pain and pain treatment has grown substantially in recent decades, as reflected in a growing number of review articles on these topics. This scoping review of reviews provides a macrolevel overview of scholarship in this area by examining what specific topics and findings have been presented in published reviews. We searched CINAHL, Cochrane Database of Systematic Reviews, Embase, PsycINFO, PubMed, and Web of Science for English-language, peer-reviewed review articles, qualitative or quantitative, that aimed to characterize or explain pain-related differences or inequities across social groups. Of 4432 unique records screened, 397 articles, published over a 56-year period, were included. For each, we documented (1) axes of social difference studied (eg, sex/gender, race/ethnicity), (2) pain-related outcomes (eg, chronic pain prevalence), (3) broad findings, (4) types of mechanisms proposed, and (5) policy or practice recommendations. Findings reveal a sharp increase in the number of published review articles on pain-related disparities since approximately the year 2000. The most commonly studied social dimension was sex/gender, followed by race/ethnicity and age. Studies examining disparities by socioeconomic status, geography, or other categories were rarer. While most findings showed disadvantaged social groups to have worse pain outcomes, there were intriguing exceptions. Biological, psychological, and sociocultural mechanisms were considered much more frequently than sociostructural (macrolevel) ones. Policy/practice recommendations were typically individual-level behavioral suggestions for providers or patients. We identify high-priority areas for future research, including greater attention to lower-income countries, chronic pain prevention, and macrolevel drivers of pain disparities.