Addressing Racial and Ethnic Inequities in Pediatric Pain Management in Emergent Settings

Pain is among the most common reasons children seek care in emergent settings, including emergency medical services (EMS) and emergency departments (EDs). Despite well-established guidelines for pediatric pain management, racial and ethnic inequities persist. The drivers of these inequities are multi-factorial. This review synthesizes the current literature on racial and ethnic inequities in pediatric pain management across the continuum of emergent care settings and highlights actionable strategies and research priorities to advance equitable pain care. Despite the known benefits of prehospital analgesia, children from minoritized racial and ethnic groups are less likely to receive analgesia, including opioids, and less likely to experience pain relief (also referred to as oligoanalgesia). Evidence regarding disparities in discharge prescribing is mixed. While identifying disparities is an essential first step, meaningful progress requires understanding the root causes and implementing multi-factorial, equity-centered interventions. Potential strategies include standardizing clinical processes to minimize variability, using equity-informed pain assessment tools and clinical guidelines, centering patient and family lived experiences, leveraging quality improvement methodologies, and re-examining clinician education to mitigate bias and improve pediatric pain care. Equity-focused research and interventions, coupled with advocacy, policy reform, and community partnerships, are essential to move the field beyond awareness toward sustainable and equitable delivery of pediatric pain care in emergent settings.