Over the past thirty years, research on pain disparities has revealed critical and enduring inequities in the assessment, treatment, and outcomes of pain— inequities that disproportionately burden diverse and historically marginalized populations. This collection seeks to trace the historical evolution of this field—focusing on older adults—as a means of identifying the systemic, structural, and methodological barriers that have sustained disparities. In doing so, this issue aims not only to deepen our understanding of the roots of inequity but also to chart a more just, inclusive, and equitable path forward.

This Research Topic aims to contextualize both the progress and the limitations that have characterized how pain is examined and research among older adults. Early research established the presence of disparities; subsequent work explored mechanisms and interventions. However, because pain is not a singular syndrome or type of pain, we must begin to view and theorize chronic pain from a layered lens, accounting for intersectionality, lifespan variability, and social acceptability. A historical analysis of this framework allows for a critical appraisal of past approaches and provides a foundation for developing a “fourth generation” of research—one that focuses on patient empowerment and liberation, precision medicine, and interventions/program dissemination from a strengths-based approach. Through this historical and future-oriented lens, the issue seeks to challenge established paradigms and constructions of pain and foster a new generation of pain disparities research—one that advances equity and justice in the lives of older adults and redefines excellence in geriatric pain management, while addressing new areas that forgo only describing the issue but identifying positive tangible solutions.

This issue invites contributions that address the following key goals:
- Map the Evolution of Pain Disparities Research: Analyze the trajectory of the field through the lens of the “three generations” (i.e., identification/documentation/description, explanation, solutions) and propose a pragmatic roadmap for a “fourth generation” focused on patient liberation, empowerment, and collaborative engagement.
- Healthy aging initiatives that focus on eliminating pain disparities and promoting pain health and well-being.
- Intra-group variability (within group): Highlight the diverse experiences and outcomes that exist among individuals of the same “identity”, reflecting the influence of intersecting factors such as race, age, gender, and sex. An intersectionality framework is essential to understanding how these overlapping identities shape health, behavior, and lived experience, rather than treating any group as monolithic. The counters prior many studies of prior years that highlight differences between groups, which often underscores that one group does not fare as well when compared to other groups.
- Identify Drivers of Disparities Across the Life Course and Health Span: Examine the structural, clinical, and methodological contributors to disparities, including early- and mid-life exposures, social determinants of health, and the intersection with geriatric syndromes.
- Advance Measurement and Mechanistic Understanding: Promote innovations in pain phenotyping, assessment methods (particularly for populations with cognitive impairment), and elucidation of mechanisms underlying psychosocial and behavioral approaches to pain management.
- Highlight Scalable and Equitable Models of Care: Showcase care models, implementation strategies, educational interventions, and economic approaches that improve access, adherence, and health outcomes among diverse older populations.
- Promote Inclusive and Impactful Research Designs: Emphasize the development and application of emerging technologies, inclusive trial methodologies, and translational research approaches that reduce bias and enhance real-world impact from bench to bedside to community.
- Redefine the Traditional Conceptualization of Pain: Propose new ways of theorizing and operationalizing pain theories and social constructions of pain that capture the diversity of lived experiences across identity and the intersection of epigenetics.

Are you interested in contributing a manuscript to this Research Topic?

Three Decades of Pain Disparities Research: Charting a Course Toward Equity in Geriatric Pain Management