Confronting Racism in All Forms of Pain Research: Reframing Study Designs

Diversity, equity, and inclusion have been a significant focus of the Pain Management Collaboratory’s research. In this three-part series, the authors examine the gaps in addressing diversity, inequities and racism in pain research.

Part two of the three-part series identifies common study design factors that risk hindering progress toward pain care equity and offers recommendation practices for reframing study designs to address these factors. Although objectivity is a cornerstone value of science, subjectivity is embedded in every step of the research process as investigators make choices about who they collaborate with, which research questions they ask, how they recruit participants, which research tools they use, and how they analyze and interpret data. The authors present theory and evidence from disciplines such as sociology, medical anthropology, statistics, and public health to discuss 4 common study design factors, including 1) the dominant biomedical narrative of pain that restricts funding and exploration of social indicators of pain, 2) low diversity and inclusion in pain research enrollment that restricts generalizability to racialized groups, 3) the use of “race” or “ethnicity” as a statistical variable and proxy for lived experiences (eg, racism, resilience), and 4) limited modeling in preclinical research for the impact of social factors on pain physiology.