Editorial: More than just Skin-Deep: Considering Ethnic, Racial, and Healthcare Disparity-based Factors in Pain Experience, Treatment, and Guidelines

Mark Vorensky^1*Zina Trost²Maisa S. Ziadni³

• ¹Department of Rehabilitation and Movement Sciences, Rutgers School of Health Professions, Newark, United States
• ²Department of Psychological and Brain Sciences, Texas A&M University, College Station, United States
• ³Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States

This special issue features four articles with distinct social contexts that converge on a shared imperative: to understand and address inequities in pain and pain care. Pain inequities are embedded within historical systems of privilege and oppression that continue to shape lived experience, research, and care (5,6). Engaging in historical and cultural study and reflection should inform how methodologies are constructed, data are analyzed, and results are disseminated (7)(8)(9). This entails an active process that contextualizes how pain researchers and their work are situated within higher-level structures and systems across history, allowing inequities across institutions, communities, and policies to be more clearly understood and dismantled (7)(8)(9)(10)(11)(12).Works from this special issue illustrate how pain is shaped by historical and structural forces. In their discussion, Kissi et Pain inequities represent collective experiences unfolding across the life course, shaped by shared histories, environments, and structural conditions (10,13). Beyond the individual, experiences of discrimination and marginalization affect families and communities, while collective resources such as cultural practices and social solidarity can shape how pain is understood and managed in the face of injustice (11,14). Addressing pain inequities requires measurement tools that are historically, culturally, and linguistically situated (15)(16)(17). Measures that are detached from the contexts in which pain is experienced risk excluding or misrepresenting marginalized populations (17). This raises critical questions about who pain assessment tools are designed for and whose experiences they capture. Disability Index illustrates the importance of aligning psychometric rigor with cultural and linguistic relevance (4). Such efforts help ensure that pain-related disability is assessed in ways that are meaningful across populations, rather than relying on instruments developed within narrow sociocultural contexts.Qualitative research plays a complementary role by capturing dimensions of pain that standardized measures can overlook (16). Giacaman et al.'s narrative approach reveals spiritual, collective, and political meanings of pain that are central to patients' lived experiences but rarely reflected in patient-reported outcomes (1). Integrating qualitative and quantitative methods allows researchers to understand where and how pain inequities manifest and supports more inclusive, context-responsive pain science (16). The articles in this special issue reinforce that pain is never "just skin-deep". Pain experiences, assessments, and treatments are shaped by historical and colonial legacies and systems of oppression and privilege that operate across individual, community, and societal levels. Whether through documenting colonial continuities in European pain inequities, highlighting Indigenous and Palestinian experiences shaped by historical loss and occupation, or developing linguistically accessible assessment tools, these contributions challenge pain researchers and clinicians to confront the broader systems in which pain is experienced and managed. Meaningfully addressing pain inequities will require more than incremental methodological adjustments. It demands contextualizing work within historical and current systems of oppression, committing to communityengaged and life course-informed research, and investing in tools and approaches that honor cultural meaning and lived experience. Importantly, foundational knowledge and solutions are constructed by communities most affected by pain inequities. By working alongside communities, pain science can move toward more just, inclusive, and effective research and care.