The Pain of Prejudice

By Carmen Renee Green, MD

As we enter a new decade, we are living in unprecedented times with a global pandemic, persistent inequities, protests for social justice, violence, and economic instability. Each threatens our ongoing health and well-being, especially for those living with pain. Never has there been a more important time to understand each other and to actively listen to each other with compassion.

Pain impacts a person’s overall physical, social, emotional and spiritual health and well-being. It can impair relationships with family and friends and yield economic instability. Both my research and clinical work reveals unequal burdens, unequal treatment, and suboptimal pain care across the lifespan for racial and ethnic minorities, women, children, older adults, low income people, cultural minorities, and LGBTQ+ communities. To begin the journey toward improving overall health, we must first understand how race, ethnicity, gender, sex, and class influence the pain experience. Until we do that, health care and pain care disparities will continue to steal livelihoods and lives. They will remain silent epidemics and major public health problems.

Unfortunately, we know too little about these vulnerable populations; more transdisciplinary laboratory, clinical and applied research is needed. Yet, too often the knowledge of what works well—such as multidisciplinary and integrative care within an inter-professional team—has not been uniformly implemented for a variety of reasons, ranging from access to care (e.g. rural vs. urban), patient and provider decision-making, and the limits or a lack of health insurance. We must come together—providers, patients, and policymakers alike—to identify solutions to provide higher quality care, improve outcomes, and advance individual, community, and population health. As a starting point in that effort, we must listen to voices that too often are unheard, like the patient stories found in this magazine.

2021 brings a new decade and an opportunity for a bolder vision for health and wellness. One where the voices of those living with pain are incorporated, especially those who are the most vulnerable, and health and pain care inequities are reduced, if not eradicated.

This issue highlights some of the work underway, but also grapples with the tough challenges ahead. I hope that these articles inspire, inform, challenge and motivate us to do more. I wish you well on your health journey.


Carmen Renee Green, MD

Dr. Green is a professor of Anesthesiology and of obstetrics and gynecology at the University of Michigan’s (UM) School of Medicine, and of health management and policy at UM’s School of Public Health. She is also an attending pain medicine physician in the Back and Pain Center at Michigan Medicine.