The Journal of Pain, Vol 23, No 6 (June), 2022: pp 913?928
Available online at www.jpain.org and www.sciencedirect.comConfronting Racism in All Forms of Pain Research: AShared Commitment for Engagement, Diversity, and
DisseminationAnna M. Hood,* Staja Q. Booker,y,z Calia A. Morais,x Burel R. Goodin,{ Janelle E. Letzen,?
Lisa C. Campbell,** Ericka N. Merriwether,yy,zz Edwin N. Aroke,xx Claudia M. Campbell,?
Vani A. Mathur,{{,?? and Mary R. Janevic***
*Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
yDepartment of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
zPain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
xDepartment of Community Dentistry and Behavioral Sciences, Pain Research and Intervention Center of Excellence, University of
Florida, Gainesville, Florida
{Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama
?Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
**Department of Psychology, East Carolina University, Greenville, North Carolina
yyDepartment of Physical Therapy, Steinhardt School of Culture, Education, and Human Development, New York, New York
zzDepartment of Medicine, NYU Grossman School of Medicine, New York University, New York, New York
xxSchool of Nursing, Nurse Anesthesia Program, Department of Acute, Chronic, and Continuing Care, University of Alabama at
Birmingham, Birmingham, Alabama
{{Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
??Texas A&M Institute for Neuroscience, Texas A&M University, College Station, Texas
***Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MichiganFunding
Research
R01MD0
R01MD0
& R01HL
K23NS12
Morais).
The authAbstract: This third paper in the “Confronting Racism in All Forms of Pain Research” series dis-
cusses adopting an antiracism framework across all pain research disciplines and highlights the signif-
icant benefits of doing so. We build upon the previous call to action and the proposed reframing of
study designs articulated in the other papers in the series and seek to confront and eradicate racism
through a shared commitment to change current research practices. Specifically, we emphasize the
systematic disadvantage created by racialization (ie, the Eurocentric social and political process of
ascribing racialized identities to a relationship, social practice, or group) and discuss how engaging
communities in partnership can increase the participation of racialized groups in research studies and
enrich the knowledge gained. Alongside this critical work, we indicate why diversifying the research
environment (ie, research teams, labs, departments, and culture) enriches our scientific discovery and
promotes recruitment and retention of participants from racialized groups. Finally, we recommend
changes in reporting and dissemination practices so that we do not stigmatize or reproduce oppres-
sive forms of power for racialized groups. Although this shift may be challenging in some cases, the
increase in equity, generalizability, and credibility of the data produced will expand our knowledge
and reflect the pain experiences of all communities more accurately.
Perspective: In this third paper in our series, we advocate for a shared commitment toward an
antiracism framework in pain research. We identify community partnerships, diversification ofsources include the following: UAB Obesity Health Disparities Address reprint requests to Anna M. Hood, PhD, Manchester Centre for
Center (OHDRC) Award & NIH Diversity Supplement on Health Psychology, Division of Psychology and Mental Health, University
1044 (NIH/NIMHD, Aroke); K23AR076463 (NIH/NIAMS, Booker); of Manchester, Manchester, UK. E-mail: anna.hood@manchester.ac.uk
09063 (NIH/NIMHD, CM Campbell); R01MD010441 (NIH/NIMHD) 1526-5900/$36.00
147603 (NIH/NHLBI, Goodin); 5K01AG050706 (NIH/NIA, Janevic); © Published by Elsevier Inc. on behalf of United States Association for
4935 (NIH/NINDS, Letzen); 3P30AG05929-04S1 (NIH/NIA, the Study of Pain, Inc.
https://doi.org/10.1016/j.jpain.2022.01.008
ors have no conflicts of interest to disclose.
913
914 The Journal of Pain Confronting Racism in All Forms of Pain Researchresearch environments, and changes to our dissemination practices as areas where oppressive forms
of power can be reduced.
© Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc.
Key words: Antiracism, equity, inclusion, bias, language.efore the colonization of the Americas and the
BCaribbean, there was no concept of “race” in theway we understand and use the word today.
Devaluation and degradation of those classified as non-
European based on physical characteristics like skin
color were used to justify an economic system that
relied on the institution of forced labor, especially
the enslavement of African peoples.63,125 The first
slave acts in Barbados in 1661 created distinctions
between “Christian servants” and “Negro slaves,” using
these distinctions as a tool of mastery.113 Carolus
Linnaeus's “Systemae Naturae” then later formally codi-
fied and ordered these racialized groupings with White
people near the top and Black people at the
bottom.63,134
The Human Genome Project disproved the genetic
assumptions upon which these classification and coding
systems were based by demonstrating clearly that
genetic variation between individuals is as small as 0.1
?0.5%, with no identifiable continental or racialized
genomic clusters.137 In fact, the greatest genetic diver-
sity is within typically defined groups, that is, 2 people
of European ancestry are more genetically similar to a
person of African ancestry than to each other.90,107 This
historical and scientific evidence shows that “race” is
not biological but rather a social construct that provides
or withholds benefits and privileges.104,125 Even as sci-
ence has made strides toward stripping away biological
conceptualizations, laying bare the social and political
functions, we are still left to grapple with the social con-
sequences of race and its constant companion ?
racism.125
Throughout this 3-part series, we use the term
“racialization or racialized” instead of “race” or
“racial.” to refer to people from non-White groups
(Table 1 for a full description). This choice highlights
that racialized “othering” serves as a political and eco-
nomic process that maintains deep-rooted White Euro-
pean hierarchies and power. These hierarchies and
associated power structures relegate non-White individ-
uals to previously unclassified social groups that now
undergird the modern concept of race.101,136 Racializa-
tion focuses on how race is defined, the meanings
attached, and how it is used to create and reproduce
racism and afford individuals the benefits of White-
ness.112 Further, because racialization is not static, some
groups (eg, individuals of Greek, Italian, and or Eastern
European origin who immigrated to the USA in the 19th
century) were first considered as non-White, but over
the course of a century, assimilated to Whiteness and
gained the associated social dominance and power.55,61
A key driver of racialization is colonialism, which is the
extended subjugation and control of sovereignty of 1
country over another country or countries that tiedblack skin color to inferiority. Colonialism was framed
not as the dehumanization of the oppressed but instead
as a “civilizing mission of lesser developed” peoples,53
which denied the knowledge of colonized peoples
along with their agency. Colonialism dominance spread
racialization globally and was used to justify the right
to limit Filipinos or Puerto Ricans the ability to self-gov-
ern, the public display of Black people in Europe in the
19th and 20th centuries, the classification of the African
Diaspora of distinct tribes and cultures as 1 universal
Black “primitive” culture to rationalize enslavement,
and the creation of taxonomies for the Indigenous Peo-
ples of Australasia and the Americas to facilitate their
erasure as a cognizable group.64
Some groups experience social and political oppres-
sion or stratification in relation to their position in a
social hierarchy (eg, caste system in India) or religion
(eg, Rohingya Muslims in Myanmar). However, colonial
anthropology also used racialization to classify and hier-
archize castes and religious groups.51 This type of raciali-
zation often operates through the lens of colorism (eg,
perceived skin tone discrimination from racialized
groups and White people) and functions similarly to
racialization as a form of hierarchy and discrimination.
For example, some Syrian Christians express their iden-
tity as “light-skin colored” of upper-caste Namboodiri
origin.51 Although it has received less attention in dis-
parities research, colorism can have significant effects
on health, with recent research demonstrating that in a
large sample of White and Black adults in the USA, in-
group Black colorism was a stronger predictor of pain
than everyday discrimination.95 This research highlights
that although previously colonialized countries have
gained their independence and landmark legislation in
the United States (USA) such as the Civil Rights Act of
1,964 forbade discrimination based on racialized iden-
tity, intrapersonal, interpersonal, structural, systemic,
and cultural policies and practices sustain inequities in
both implicit and explicit ways to the detriment of psy-
chological and physical health.7
Despite the fallacy of “race neutrality,” racist policies
continue to impact every system in society, including sci-
entific inquiry. Science has its own shameful history of
overt racism, like the Eugenics Movements in both the
USA and Europe that later fueled the genocides of Jew-
ish and Romani people in Nazi Germany77 and “The Tus-
kegee Study of Untreated Syphilis in the Negro
Male,”20,72 an enduring example of unethical research
conduct resulting in intergenerational harm to Black
men in the USA and their families.114 Examples of con-
temporary scientific racism, such as research that ties
racialized disparities in COVID-19 burden to gene
expression23 continue to pathologize Blackness. Opara
et al. 2021 labeled this conflation of race and genetic
Hood et al The Journal of Pain 915
Table 1. Explanations of Common Language Choices in Scientific Narratives and a Commonly Used Underlying Research Framework in Pain
Research With Proposed Shifts Based on an Antiracism Framework
COMMON APPROACH PROPOSED SHIFT* RATIONALE FOR SHIFT
KEY TERM DEFINITION KEY TERM DEFINITION
Common Underlying Research Framework
Non-Racism The passive rejection, opposition, Antiracism The active process of eliminating racism by Calls on investigators to actively build cultural
and disassociation from behav- changing systems, organizational structures, humility, self-reflect on study design choices, and
iors, discourses, and ideologies policies and practices, and attitudes, so that engage in power-sharing and other behaviors
that are considered racist power is redistributed and shared equitably that will bring the field of pain closer to justice for
racialized groups
Common Language Choices in Scientific Narratives
Race/Racial Social classification of individuals Racialized identity or racialized A social process by which racialized meaning Indicates the action of White European societal and
based on a mix of physical fea- group identity when referring to is ascribed to a group of individuals that pre- structural influences in creating and perpetuating
tures (eg, skin tone and hair racialized groups; “Race” (in viously did not identify as such; historically, racialized groups and hierarchies based on those
texture) quotations) when referring to White Europeans racialized individuals who groups (ie, acknowledges the sociopolitical pro-
White people or the general did not have similar physical features to their cess) rather than implying distinct classes of peo-
construct own, leading to "othering" and differential ple (ie, might be inferred as biologically based);
treatment; because White people initiated We use quotation marks around the term “race”
the process of racialization, in our series, we where relevant to connote that it is a socially con-
do not refer to White people as being structed, dynamic phenomenon
racialized
Minority A distinct group that coexists with, Minoritized Group(s) in society that are defined as "minor- While used by some to denote minority percentage
but is subordinate to, a more ities" by a dominant group of the population, this term has taken on conno-
dominant group tation that that racialized groups are relegated to
a "minority" status by White dominant society
Social Determinants The conditions in the environments Social Indicators of Health An imperfect replacement term that seeks to Indicates that conditions are not fixed and can
of Health where people are born, live, emphasize social factors that contribute to change across the lifespan, be surpassed because
work, play, and age that affect health outcomes while moving away from of resilience factors, or change with intervention
health, functioning, and quality deterministic language (see Salerno &
of life that ultimately lead to poor Bogard, 2019)
health outcomes
People of Color, Naming conventions typically used Use individuals' preferred identities For example, "Black" or "African American" Rather than passively cluster pan-ethnic identities ?
BIPOC, non-White to refer to racialized groups or "racialized group(s)" or "Jamaican American" when referring to which erases their heterogeneity ? using individ-
a particular identity; "Racialized groups" uals' preferred identity is a step toward recogniz-
can be used when referring to individuals ing unique lived experiences, and using
spanning more than 1 pan-ethnic category "racialized" actively acknowledges the reason for
lumping these groups together
Abbreviation: BIPOC, Black, Indigenous, People of Color.
*Because semantic change occurs continually, the utility of these proposed shifts should be closely monitored over time. As needed, new terms that hold systems accountable and validate the experiences of racialized individuals should be
used.
916 The Journal of Pain Confronting Racism in All Forms of Pain Researchancestry as a “modern-day Drapetomania” ? the non-
sensical notion that created a biological cause for
enslaved people running away.102
We see the insidious, but no less profound, influence
of scientific racism in health care with increased mater-
nal deaths for Black women compared to White women
in the USA84 and the United Kingdom (UK)83 and
reduced mortality for Black newborns cared for by Black
physicians in the USA.57 Most recently, a medical center
policy in NewMexico (USA) separated only Native Amer-
ican women from their newborns as a “precaution”
against the spread of COVID-19,48 and maternal mortal-
ity in Black women in Brazil due to COVID-19 was almost
2 times higher than that observed for White women.116
Ignoring historical and modern-day patterns of oppres-
sion promotes inequities in research and clinical practice
and does not address systemic issues.38 Instead, mindful-
ness that scientific knowledge continues to benefit
White people from Western, educated, industrialized,
rich and democratic (so-called WEIRD) countries is neces-
sary to change the status quo in all scientific fields,
including pain science.94Shared Commitment
In this third paper in the “Confronting Racism in All
Forms of Pain Research” series, we will build upon the
call to action (Morais et al., in this issue96) and reframing
of study designs (Letzen et al., in this issue85) and con-
tinue to highlight an antiracism perspective and a
shared commitment to change or enhance current
research practices through a critical race theory (CRT)
lens. CRT provides a framework for investigators to
remain attentive to equity throughout the research pro-
cess.41 Terminology and language choices in this 3-part
series have been deliberately chosen to reduce harm.85
However, when specific examples have been provided
or recommended, the goal is to improve clarity and
acknowledge structural and cultural forces (ie, race vs
racialization) rather than serve as the “only” option.
Instead, we ask researchers to pause and reflect on ter-
minology choices carefully with specific consideration
for the preferences of the communities from which their
samples are drawn, particularly those communities that
have been under-represented in research.
Pain research has often focused on individual-level
factors (eg, patient beliefs, genetic susceptibility) whilst
adopting a deficit-based approach (eg, focusing on the
perceived weaknesses of racialized groups). This
approach does not allow for a deeper consideration of
social, economic, and policy factors outside of the indi-
vidual’s control, driving persistent disparities in pain
outcomes.123 We contend that together researchers can
overcome these limitations through a shared commit-
ment to interrogating racism as a critical driver of racial
health inequities in the design, recruitment, analysis,
interpretation of findings, and dissemination of pain
research.110 We view our series as the beginning of this
collective commitment toward antiracism instead of a
prescriptive guideline, where together, we can addressunequal power differentials experienced by racialized
communities and the deep connections to pain dispar-
ities.7 Without these changes in thinking and behavior,
we will continue to reproduce old patterns of inequities
and lessen our ability to alleviate pain across all
groups.94
This work will emphasize the systematic disadvantage
experienced by racialized groups globally whilst
acknowledging that these heterogeneous communities
have complex identities, histories, and cultures and that
social and political oppression work through different
mechanisms across cultures.119 Specifically, we will dis-
cuss how forming community partnerships through
engagement building can increase the participation of
racialized groups in research studies and enrich the
knowledge gained. Additionally, we will highlight why
diversifying the research environment (ie, research
teams, labs, department culture) promotes recruitment
and retention of participants from racialized groups
and the need for changes in disseminating research
findings. Although challenging, the rewards are mani-
fest, and this shift will produce knowledge that reflects
the pain experiences of all communities more accu-
rately.Community Partnerships and Engagement
Building
A critical component in moving pain science toward
an antiracism framework is forming partnerships with
patient advocates and community stakeholders
throughout the research process. Researchers can inad-
vertently approach a project with a predetermined
agenda that fails to include the community’s needs
rather than co-producing knowledge. To gain buy-in
from communities, this involvement cannot be a tick
box exercise or an afterthought but instead works best
as a feedback loop that is of mutual benefit with shared
ownership of research ideas and achievements.79 To fos-
ter this process, researchers will have to move out of tra-
ditional silos and, from the projects’ inception, aim to
understand the interwoven history, climate, culture,
and values of the people that may participate in the
study.7
Before the project starts, the research team can com-
plete an environmental scan (formal or informal). Envi-
ronmental scans have been used frequently in
healthcare systems and are an effective approach to
seek, gather, and interpret information to inform deci-
sion-making and planning.24 Through listening, observ-
ing, and reviewing publicly available resources, the
team can begin to understand the current community
policies and practices, better understand the existing
systems and institutions, increase the credibility of the
project, and enhance usefulness by aligning project out-
comes with what the community perceives as their social
and health goals.7,133 Pain scientists could also consider
conducting a pilot needs assessment to systematically
ascertain the “gaps” between current conditions (eg,
Hood et al The Journal of Pain 917sociological or health) and the objectives of the research
study.60
Community-Based Participatory Research
The approach of establishing meaningful connections
with communities to achieve shared research goals is
exemplified by the community-based participatory
research (CBPR) tradition, which is often seen as the
gold standard for community-engaged research.
Although CBPR was first widely used in the 1990s in the
USA,81 it builds upon a rich history of social and political
movements that advocated for communities as the pri-
mary sources of solutions for their own challenges,46
The CBPR approach emphasizes cultural humility to sup-
port power-sharing between academic researchers and
communities, as well as the application of research find-
ings for social change and the reduction of health dis-
parities. Therefore, it is an appropriate approach for
addressing the justified mistrust of the health research
establishment on the part of racialized groups.75
Other well-defined CBPR principles include: 1)
research should equitably involve community represen-
tatives in all aspects of the research process, 2) benefits
of the research should accrue to all partners equitably,
3) a strengths-based rather than a deficits-oriented
framework should guide work with communities and,
4) co-learning should occur between community and
academic partners. Researchers can conduct interviews,
focus groups, community dialogues and equity-focused
listening sessions to gather stakeholders’ perspectives
and ensure that stakeholders are enabled throughout
the entire project with co-ownership of data interpreta-
tion (both quantitative and qualitative), sharing the
project impacts, and co-authorship of conference pro-
ceedings and peer-reviewed publications.76,131 CBPR
shares a philosophy of valuing partnership and collabo-
ration with Patient Public Involvement (PPI) utilized in
Europe and the UK, along with decolonizing research
methods used by researchers in African countries such
as South Africa, Kenya, and Nigeria. Shifting from “
power over” to “power with” in participatory research
and acknowledging what can often be a Eurocentric
research worldview lays the foundation for collabora-
tion and trust, including making research materials
available in the local language (eg, in Yoruba even if
participants also speak English), promoting local ways
of knowing, and recognizing individual and community
assets.36,80
Some recent studies have demonstrated the principle
of co-producing knowledge with patients with sickle
cell disease (SCD), their caregivers, and other stakehold-
ers (eg, patient charities, service improvement experts)
from the earliest planning stages (eg, proposal
development) before applying for funding so that
stakeholders can be compensated for their time.31,70
Patients with SCD can receive racialized care and pain
treatment.66,98,109 As such, this population provides a
valuable illustration for pain scientists incorporating
CBPR into their research. During this collaborative pro-
cess, via in-depth qualitative interviews and assistance
in designing research tools, stakeholders have co-designed an app to improve self-management,32 tested
and provided input on virtual reality patient avatars
and messaging,32 formed stakeholder advisory boards
to advise on recruitment and retention strategies,70 and
identified the critical challenges for the transition from
pediatric to adult care as feeling disregarded, ques-
tioned, or made to feel invisible when they demon-
strated expertise about their pain treatment.92
Despite the clear benefits of the CBPR approach,
researchers wishing to alleviate health disparities often
face practical barriers (eg, time, funding, and connec-
tions) to using the “full” CBPR approach. In recognition
of this, Key et al. (2018) present a continuum of commu-
nity engagement in research, from consultation with
partners on 1 end to community-driven research on the
other. The spectrum is flexible and identifies different
entry points for community involvement, highlighting
“leverage points” related to context and equity to sup-
port community-academic partnerships.82 Critically,
however, when any degree of CBPR is implemented, the
goal is to be transparent, respectful, and reciprocal.
The utilization of CBPR principles in preclinical
research remains in its infancy. Fox et al., 2021 found
only 32 preclinical studies (in vivo and in vitro) have
incorporated public engagement, with the majority
conducted in the USA, UK, and Europe. Studies assessed
included a range of conditions, including cancer,
Alzheimer’s disease, autism, with some studies including
pain populations, primarily rheumatic and arthritis con-
ditions. Currently, however, no preclinical studies have
incorporated patient engagement at the data collection
and data analysis investigative stages.43 Researchers
have indicated that limits of citizen capacity, the com-
plexity of science, the need for professional autonomy,
and less scope for CBPR to beneficially impact research
as reasons not to include patient involvement in preclin-
ical studies.10,108 This cycle of low expectations has led
to low investment,52 even though public participation
in preclinical work could support efforts to conduct
research in an ethical, accessible, and transparent man-
ner whilst also generating novel ideas.88 Additionally,
involving the patients throughout the project in specific
tasks (eg, assisting with data access) can help create
research that reflects the balance and diversity of priori-
ties within the population.99
Community-engaged research traditions, particularly
CBPR, laid the conceptual groundwork for the models
of stakeholder engagement required for funding and
support through the Patient-Centered Outcomes
Research Institute (PCORI) in the USA, the PPI Initiative
in the UK, and the European Patients' Academy on Ther-
apeutic Innovation (EUPATI).16,44,122 Like CBPR, PCORI
and PPI models promote genuine partnership in deci-
sion-making at each step of the research process. Impor-
tantly, it is increasingly supported by other major
funders, for example, by the National Institutes of
Health (NIH) in the USA as part of their HEAL (Helping
to End Addiction Long-term)47 initiative to address
chronic pain and opioid misuse and the National Insti-
tute for Health Research James Lind Alliance in the
UK.126 However, expanding the funding opportunities
918 The Journal of Pain Confronting Racism in All Forms of Pain Researchoutside of these specific mechanisms along with creative
thinking and flexibility from funding bodies is needed
to support this work. For example, a recent supplement
to the NIH HEAL Initiative in the USA funding that sup-
ports strategies to increase participant diversity, inclu-
sion, and engagement in clinical studies could help pay
competitive wages to non-traditional research staff (eg,
supplements for community health workers)73 or allow
for adjustments in deadlines to obtain adequate stake-
holder input.93
Such stakeholder-engaged approaches align with
principles of antiracism in that they give racialized pop-
ulations a voice in the conduct of research, including
the prioritization of research questions that will address
disparities; ensuring that recruitment and retention
strategies are accessible and equitable; and that data
collected reflects the lived experience and priorities of
the people under study. Ample guidance is available for
researchers who wish to use these approaches, from eth-
ical compensation of stakeholder-partners to demon-
strating how to ensure fair and transparent governance
of stakeholder bodies.27 For other practical guidance
specific to pain science, Janevic et al. (2021) also provide
tips for engaging stakeholders and communities in pain
research, including a checklist for researchers.78Participant Recruitment and Retention
Individuals from racialized groups often do not
believe that scientific findings will produce beneficial
results for them.28,74 Recruitment methods have
remained stagnant and, for the most part, in WEIRD
countries are still targeted to recruit White participants.
Disclaimers for low participation of racialized individu-
als in pain research include “hard-to-reach” orFigure 1. Opportunities to improve recruitment and retention anharboring “mistrust” without acknowledging the sys-
temic barriers faced or the significant role of racism in
institutional and medical systems.19 The onus is on
racialized groups with the attribution that “mistrust”
drives disparities without recognizing that within our
approaches and systems, there are valid reasons for
skepticism. By not acknowledging the barriers and sup-
porting the facilitators to the inclusion and retention of
racialized participants in research, we reduce our knowl-
edge, delay understanding of factors contributing to
poor outcomes among racialized populations, and pre-
vent the receipt of high-quality care.50,117
Applying an antiracism framework using CBPR princi-
ples offers a way to rebuild trust and increase the
engagement of racialized groups in pain research. This
process begins with carving out protected time during
work hours to include diversity, equity, and inclusion
training. A large-scale meta-analysis of over 260 studies
indicated that integrated programs worked best with
training that focused on skill-building and awareness.14
A recent successful example of this type of training
implemented a pain-focused health equity curriculum
(ie, defining, examining, and discussing ways to
reduce implicit bias) at an academic institution.4 Team
members could also complete confidential question-
naires to assess their a priori assumptions relative to
each research question.42 In addition, regular commu-
nity interactions (in-person or virtual) can engender
trust,54 reduce negative perception, and strengthen
connections.118,135 Listening sessions in collaboration
with leaders and familiar key players (ie, clinic staff at
medical clinic, server at local restaurant) provide an
opportunity to hear suggestions about overcoming bar-
riers to participation and better understand local cul-
tural attitudes and norms (Fig 1).d build trust with participants in pain from racialized groups.
Hood et al The Journal of Pain 919Responding to community partner feedback about
recruitment efforts and including community members
in the recruitment process can remove the distance
between potential participants and the research team.
Similarly, it is helpful to have an appreciation that racial-
ized populations may be exposed to additional harm
due to the lack of established social infrastructures (eg,
medical and community facilities)118 and that immigra-
tion and criminal justice policy may limit a researcher’s
ability to compensate some participants from racialized
communities for their time adequately (eg, limited
access to USA federal and state funding to pay undocu-
mented immigrants).130 Therefore, studies that include
undocumented participants should assess the risk of
gathering individually identifiable information and
tracking the compensation and may instead consider
offering something other than monetary remuneration
as compensation (eg, meals, transportation, free care).56
Transparency during the informed consent process
where the reasons and options for compensation are
clearly stated can help participants understand payment
options and make them feel more comfortable accept-
ing compensation.100
To create strong community-academic partnerships,
efforts to engage community members and trusted
community gatekeepers must begin early, ideally before
the recruitment phase. Monthly meetings of community
advisory or study advisory boards with the representa-
tion from racialized groups that match the characteris-
tics of the intended study sample add significant
value.86 By obtaining perspectives of racialized individu-
als affected by pain, researchers can inquire about how
their institution connects with community members,
how the community will receive their study, and identify
any potential barriers. These efforts contribute to build-
ing trust by providing community members with a voice
in the research process and raising awareness about the
role of research participation in developing new treat-
ments that will benefit marginalized populations.35 To
avoid burdening any 1 individual or organization and
to ensure the representation of diverse perspectives,
researchers should take the time to establish broad and
deep relationships across the community to avoid over-
burdening any 1 individual or organization. Through
this process of relationship building, the research team
can demonstrate sensitivity to and appreciation for the
community as a valued partner.
Essential to research participation is the dissemination
of recruitment materials (eg, study announcements).
Efforts may be ineffective if the materials are unneces-
sarily complex or if study procedures appear too bur-
densome. To help ensure research communication
meets the comprehension standards for ethical research,
we recommend using plain language practices. That is,
clear communication that can be understood the first
time it is read or heard. Plain language is not “dumbing
things down “or only applicable for individuals with
low literacy; instead, plain language refers to communi-
cations that are accessible for the intended audience.
Some strategies for plain language include: (1) writing
in short sentences, (2) using active voice, and (3) wordsfamiliar to the audience (eg, “use” instead of “utilize”),
and the inclusion of images that illustrate content to
make it easier to understand.124We also recommend
employing images that reflect the diversity of the popu-
lation; this includes representation of various racialized
backgrounds as well as socioeconomic statuses to reflect
the heterogeneity of the population. Moreover, trans-
late recruitment materials into languages other than
the dominant language of the country in which the
study is being conducted.120,121 Of note, when complet-
ing language translations (from the original language
to target language), special attention is needed to
ensure that translators are also bicultural to generate
culturally-responsive translations that address the dis-
crepancies and cultural ambiguities that occur with text
translations.57
Flexibility in data collection methods acknowledges
the efforts required for participants from racialized
groups.17 When describing the research study, research-
ers can also include information regarding study proce-
dures that recognize primary logistic and financial
barriers, including transportation barriers and time
commitments that may appear burdensome for a popu-
lation unfamiliar with research. Culturally-appropriate
incentives, along with data collection flexibility, can
also reduce obstacles (Fig 1). These recruitment and
retention strategies, although not exhaustive, can foster
participants from racialized groups beliefs that their
participation will help others or their communities and
increase health-related knowledge with minimal
risk.74,86,111 To reduce secondary barriers that influence
willingness to participate even when the more obvious
logistical and financial barriers have been reduced, it is
critical to build trust and credibility and convey the
appropriate information about the benefits of research.
These strategies will promote understanding and chal-
lenge the short-sighted stereotype that individuals from
racialized groups are hard to recruit or unwilling to
engage in research.59,61Diversifying Research Environments
Pain research and clinical practice infrastructures sup-
port interdisciplinary teams from fields including neuro-
science, neurology, psychology, medicine, data science,
population health, and statistics to characterize the cel-
lular, neurological, and psychological mechanisms that
regulate pain. Unfortunately, the same financial and
institutional supports have not been equally focused on
ensuring that research teams are diverse and include
racialized groups. Social epidemiologists and behavioral
scientists also represent untapped expertise related to
understanding the effects of racism in pain outcomes,
with “interdisciplinary” rarely reaching beyond the
usual biomedical spaces. A team science approach oper-
ates at the highest levels when contributions and per-
spectives of researchers from racialized groups are
included and elevated.94 Increased diversity of the
research team needs to occur across all pain disciplines
920 The Journal of Pain Confronting Racism in All Forms of Pain Researchin preclinical and human participants studies to drive sci-
entific discovery.
To fully realize the potential for innovation, inclusivity
can be cultivated at multiple levels (eg, undergraduate,
graduate, faculty, administration). The responsibility for
diversifying research teams cannot fall disproportionately
on principal investigators (PI) from racialized groups. We
must ensure that contributors from racialized groups can
share intellectual contributions that can lead to the dis-
semination of findings and potential future funding.25
This is not a purely benevolent exercise. Racially and lin-
guistically diverse teams in which leadership roles are
shared have several significant benefits.18 They achieve
better community stakeholder participation of racialized
populations, incorporate multiple perspectives, publish
more papers, and receive more citations per paper.45 Part-
nering across institutions, particularly with academics at
historically Black colleges and universities, Hispanic-Serv-
ing Institutions, Tribal Colleges and Universities, Asian
American, Native American, Pacific Islander-Serving Insti-
tutions, and community colleges, can promote scholarship
from racialized groups whilst increasing trust from partici-
pants underrepresented in research studies.22
Diversifying Teams
We advocate for diverse teams with equal participa-
tion from individuals from racialized groups, and there
is merit to using racialized group identity to match
research assistants with the study population. How-
ever, it is often not possible due to lack of diversity in
the research workforce, and even when possible is not
sufficient to remove biases. Instead, a deeper examina-
tion is necessary. Cultural competence and cultural
humility should be a central component of the
departmental culture focusing on self-reflection and
awareness (Morais et al., in this issue for more
detail96). Ahmad et al. (2019) present evidence-based
strategies to select, recruit, and retain undergraduate
students from racialized groups in the USA,6 whilst
Chaudhary et al. (2020) provides an excellent overview
describing how to build an anti-racist lab.25
Briefly, they recommend helping postdoctoral, grad-
uate, and undergraduate students build networks
through culturally relevant professional societies (eg,
Society for Advancement of Chicanos and/or
Hispanics,3,40 Black British Professionals in STEM,13 the
Aurora Education Foundation for Indigenous scholars
in Australia). Promising candidates can be identified
quite easily outside the usual predominately White
networks in the USA using targeted listservs and data-
bases (eg, DiverseScholar.org, minoritypostdoc.org),
connecting with programs aimed to increase represen-
tativeness in higher education (eg, Maximizing Access
to Research Careers [MARC] Scholars, McNair Scholars),
and attending conferences focused on increasing
diversity in the academy (ie, Understanding Interven-
tions that Broaden Participation in Science,128 Annual
Biomedical Research Conference for Minority
Students8,30). Although most of the programs
highlighted are in WEIRD countries, we encourage
researchers to search for similar resources for racialized(eg, Indigenous Peoples) and socially oppressed groups
in their regions and countries.Departmental Culture
PIs should foremost assess the lab and departmental
culture to ensure they are not recruiting students from
racialized groups into toxic environments. This requires
allyship, which means actively working to advance the
culture of inclusion through intentional, positive, and
conscious efforts.12,132 To be an ally, words and actions
must be in sync. When students from racialized groups
courageously share their experiences of racism ? believe
them. Small steps can have a significant impact, such as
creating safe spaces for all students to discuss racialized
identity and racism and to report events when they hap-
pen. However, continual investment is needed.
Researchers should advocate for specific, actionable
departmental policies where racialized disparities can
be discussed and action plans are developed, including
regularly (eg, once a semester or term) collecting anony-
mous student data through climate surveys, paired with
transparent, aggregate reporting of the survey’s results.
Key points from the survey need to lead directly to
change.49
Creating this supportive environment depends upon
a shift in the department culture from the more
common “diversity-focused perspective” in which
departmental leaders focus on increasing the number
of recruits from racialized groups with interventions
focused on fitting the racialized scholar into the exist-
ing majority White institution. This practice often
includes little recognition of why individuals may not
want to apply or stay within these types of environ-
ments. Instead, we support Griffin’s call for the adop-
tion of an “equity-focused perspective” in which the
emphasis shifts from the racialized scholar to the insti-
tution and the policies and structures (eg, faculty bias
in hiring, tenure, and promotion) that perpetuate
inequities and inhibit the ability to increase and main-
tain faculty diversity.58
Allyship also requires understanding that colleagues
from racialized groups often undertake extra, mostly
uncompensated work that their White peers are not
asked to do. This cultural taxation, more colloquially
known as the “Black or Brown Tax,” is infrequently
rewarded in promotion and tenure and can involve serv-
ing on multiple equity and inclusivity committees or
mentoring students or junior colleagues from racialized
groups.105 This is not to say racialized scholars are not
invested in these issues and want to give back, but these
requests are in addition to current workloads and can
easily lead to burnout.59 Making these shifts in
departmental culture advances the goal of a shared
commitment toward an antiracism framework by reduc-
ing the relative homogeneity of pain scientists and
expanding the range of questions asked. Moreover,
racialized scholars may be more likely to prioritize com-
munity partnerships and knowledge translation.11
Finally, diversifying the speakers at departmental collo-
quiums supports both the invited researcher and the
Hood et al The Journal of Pain 921students. When organizing these workshops or sympo-
sia, researchers from racialized groups should be invited
to co-lead and not just participate.Toolkits and Funding
Recognizing that diversifying the student body and
making changes to the departmental culture is every-
body’s responsibility. Taking on or providing support
for some of these roles (when appropriate) will increase
the cumulative effort to improve diversity, equity, and
inclusivity.26 Research led by racialized scholars is often
under-cited across all pain research fields, including
pain disparities, which devalues these academic contri-
butions. As this work provides the basis for our field’s
knowledge of the effects of racism on pain outcomes, it
is critical to value and include racialized scholars.5 In
support of these necessary changes, the Toolkits for
Equity project have created the freely available Antirac-
ism Toolkit for Allies,34,127 which provide a common
framework, shared vocabulary, and best practices. Aca-
demics for Black Survival and Wellness2 is a personal
and professional development initiative for Non-Black
academics. As a truly international collective of over
10,000 participants, the initiative provides training
materials along with a supportive online community to
make an actionable change whilst also providing a heal-
ing and wellness space for Black people.
In addition to the personal and professional develop-
ment resources described above, funding sources for
minoritized graduate and postdoctoral students have
been developed across numerous academic institutions.
If an initiative does not exist, providing active support
for such an effort and highlighting the need to improve
recruitment of racialized groups at the institution can
be a shared goal.49 External funding for racialized stu-
dents is also available through grant opportunities in
the USA from private foundations such as the William T.
Grant Foundation1 and federal through the NIH diver-
sity supplements.67Dissemination of Research Findings
Dissemination of research is a critical point in the
research process.62 Within our research silos, we have
begun to more thoroughly examine policies, practices,
and procedures that give rise to specific types of bias
(eg, publication bias). However, an application of an
antiracism framework along with disseminating find-
ings outside of peer-reviewed publications to sectors in
policy, clinical practice, science, education, and business
have traditionally been secondary or absent goals. Dis-
semination of results directly back to patients and/or
participants and community partners, particularly those
who are racialized, marginalized, and stigmatized, hap-
pens even more infrequently, limiting our ability to
improve knowledge about pain as well as identify
multi-level approaches for addressing pain disparities
and inequities.
The most conventional approach to disseminating
pain science research is through peer-reviewedpublications. Although this dissemination avenue
receives the most time and effort, authors do not often
consider how elements of the manuscript may perpetu-
ate racism and bias. For example, racialized categories
may be needed to identify and remediate inequities,
but as a consequence, the focus on differences may rein-
force racism.71 Race must be acknowledged as a social
construct that is tangibly experienced and shifts in terms
of context, setting, and geographic region. Because this
process of conceptualizing and contextualizing race can
be challenging, some pain researchers may be tempted
to avoid mentioning racialized experiences at all, but
the critical significance of race in all of our lives cannot
be ignored. Even when there is compelling evidence of
discrimination, scholars may use overly circumspect lan-
guage that does not directly describe practices as racist.
Harawa and Ford (2009) highlight that questions such as
‘‘Is it race or racism?’’ inadvertently yet inaccurately sug-
gest that there exists a neutral “race” that is neither a
product of nor affected by racialized stratification.63
Further, hypotheses or objectives also need to be exam-
ined to ensure that they do not have racist, stereotypi-
cal, or inferiority undertones (eg, White participants
will use more adaptive “problem-focused” coping styles
to manage pain, whereas Black participants will use
more maladaptive “passive” pain-coping styles).
Reducing Language Bias
In disseminating research findings, the use of inclusive
culturally and community sensitive language can help
ensure that participants are treated with respect and
dignity, avoid harmful labels, and are perceptive to dif-
ferences when characterizing study samples. In short,
our words matter. There is a fallacy that long-term use
of labels justifies their continued use, but this ignores
that language is constantly evolving.38 We can find
alternatives that do not inflict harm. Resources on incor-
porating culturally and community sensitive language
are increasingly available from professional organiza-
tions relevant to the care of individuals with pain,
including the American Psychological Association
(APA)15 and the American Medical Association
(AMA).9,39 Use of these guidelines is not exhaustive, but
it will reduce bias when reporting and discussing racial-
ized groups through the use of capitalization in descrip-
tions of racialized categories (eg, Indigenous People),
removing the use of outdated terms (eg, Caucasian),
and not using the term “Other” and collapsing groups
with distinct identities into this single category. Addi-
tionally, characterizing participant self-report of racial-
ized discrimination as “perceived” may seem benign,
but within the antiracism framework, it can be acknowl-
edged that a history of invalidation accompanies this
term for racialized groups.129
Other broader ways to incorporate culturally and
community sensitive language also fit well within an
antiracism framework. For example, using gender-inclu-
sive language by discontinuing the blanket use of male
terms and utilizing the gender-neutral pronoun “they”
instead of “he/she.” When describing age, use “years of
age” and avoid using words such as “experienced” or
922 The Journal of Pain Confronting Racism in All Forms of Pain Research“seasoned” for older adults.33 Person-first language is
also a way to emphasize the individual first rather than
the illness, for example, changing the term “chronic
pain patient” to “person living with chronic pain.”
Although subtle, this difference shifts the focus toward
the individual and highlights the person, not just the
condition. Importantly, for all aspects of culturally and
community sensitive language, these changes must be
applied to all groups, including control samples — this
change highlights that everyone is a person first, not
just those experiencing pain. Because preferred terms
may vary by community and over time, working closely
with communities whilst using cultural humility
throughout the research process will enable researchers
to learn the terms that are affirming and meaningful to
a given community.
There have been multiple calls to focus our scientific
language on the structure or system rather than the
individual.37,115,129 Recently, O’Reilly (2020) answered
this linguistic call to action by emphasizing “systems-
centered language.”103 Systems-centered language
seeks to end the dehumanization of people that occurs
whilst discussing how they are experiencing oppression.
For example, people who are “at-risk” have been
exposed to harm from a specific circumstance. Yet,
when we use this term, the system causing the harm is
rarely identified. A possible replacement term is
“community exposed to additional harm,” which shifts
the onus onto the system that is adding burden. We sug-
gest that harmful labels or even traditional or com-
monly-used terms be examined through a systems-
focused lens. Or, explained by O’Reilly, “we cannot dis-
mantle what we dismiss!” Table 1 highlights some of
the terms O’Reilly discussed and other potentially harm-
ful labels. Critically, we view this table as an iterative,
ever-evolving document that should be continually eval-
uated against society’s contemporary application of
labels. Many unequivocally harmful labels began as
benign medical terms but later became paired with
damaging connotations, so the alternatives we have
provided now may later need to be modified. Addition-
ally, the alternatives provided are not exhaustive, and
we suggest that researchers choose the most appropri-
ate systems-centered modifications for their specific
studies, populations, and countries.Context-based Reporting
When we do not examine racism and its effects, trou-
bling assertions of unmeasured biological or genetic
reasons for racialized differences19 in pain outcomes
can occur as described in papers 1 and 2 in this series
(Morais et al., in this issue96; Letzen et al., in this issue85).
This practice can have a devastating influence, such as
White medical students and residents holding false, fan-
tastical beliefs related to innate biological reasons for
racialized differences in pain perception.68 With regard
to culturally and community sensitive reporting, using
an antiracism framework can begin with authorship.
Some, primarily qualitative-focused and nursing jour-
nals (eg, Advances in Nursing Science), have manuscriptauthors include positionality statements with content
that can reflect the author/s characteristics (eg, nation-
ality, demographics) or culture (eg, personal life experi-
ences)69 to understand how identity may influence the
design, interpretation, and reporting of study out-
comes. Some quantitative-focused journals (eg, the
Journal of Social and Personal Relationships) are also
now encouraging authors to make this shift. We advo-
cate for this change in pain-focused journals as well, as
it helps authors and readers recognize power and privi-
lege and supports reflection of the contribution to bias
and subjectivity.22 However, because this choice may be
more complicated for people of marginalized and hid-
den identity categories, solidarity from those with privi-
leged identities along with support from editors from
pain focused journals would help with this transition.
To demonstrate 1 way to adopt this practice, the
authors of this 3-part series have included positionality
statements in Morais et al., in this issue.96
Precision in terminology along with clear, consistent
definitions, operationalizations, and differentiation of
the constructs of racialized identity and culture aid com-
prehension.87 As this may differ between countries, it
can be as simple as stating the exact definition of “race”
(ie, Black or White people) or ethnicity (eg, ancestry,
religion) used in the study, how and why this term was
derived (eg, USA National Institutes of Health reporting
guidelines), and a description of the methods used to
obtain the data (eg, participant self-report). Justifica-
tions must be included, and we should no longer accept
poor or absent explanations for missing data pertaining
to “race.” Underscored by Buchanan et al. (2021), we
need to report “race” of all study participants as ignor-
ing or reporting for only 1 group upholds Eurocentric
hierarchies and practices. Even when the racialized iden-
tity of all groups is reported, it is commonplace to see
the White sample at the top, followed by categories of
racialized groups. This grouping can be explained
because the White sample is the largest, but it can also
denote that White individuals are first in our social hier-
archy. Instead, authors should consider listing groups
alphabetically.
Our citation styles (eg, APA, MLA) are also designed to
capture Western knowledge, making it harder to incor-
porate Indigenous Peoples oral teachings into peer-
reviewed articles. Current practice cites these oral tradi-
tions and ways of knowing as personal communications
akin to a phone call with a colleague.89 Perhaps unwit-
tingly, this results in a scholarly denial of oral histories.
To increase the ability of scholars to include the exper-
tise of Indigenous Elders and Knowledge Keepers, Lori-
sia MacLeod has created citation templates so that
Indigenous oral history can be presented as an equal
and valid form of information.89 As we engage Indige-
nous advocates and patient voices into pain science, it
will be important to utilize these templates and other
appropriate resources to demonstrate respect for these
revered teachings.
When results are discussed and implications consid-
ered, evaluation through an antiracism lens can be facil-
itated by examining the larger systems, policies, and
Hood et al The Journal of Pain 923social conditions that contribute to study outcomes (eg,
access to healthcare).91 If results specific to individuals
from racialized groups are assessed, highlighting
strengths (eg, protective factors of community pride and
family cohesion) and areas of parity with White partici-
pants whilst recognizing the role of intersectionality ?
how holding multiple marginalized identities (eg, Black
and immigrant) influences experiences interactively and
inseparably ? will contextualize findings.94 With regard
to study limitations, pain researchers defend and discuss
the limitations of all aspects of our research design and
analyses. We advocate that the same care and attention
be extended to antiracism practices so that these practices
and self-critique of our work through an antiracism lens
become the norm for research dissemination across all
pain disciplines.49 Toward this end, antiracism guidelines
are beginning to be included in author instructions at aca-
demic journals (eg, Palermo et al. 2021106) and are being
developed by the Antiracism CoaliTION in Pain Research
(ACTION-PR) (co-authors in this series) for submission to
pain specific journals. Ultimately, researchers who have
engaged with racialized groups and included them fully
in the research process in the ways we have suggestedwill
be better positioned to discuss racialized lived experien-
ces, including how experiences of racism impact pain out-
comes. This will be particularly important for
dissemination to the broader community of pain research
stakeholders.Dissemination to Broad and Diverse
Audiences
Our current dissemination model rewards sharing our
findings with other scholars in similar disciplines in a
specific, circumscribed manner (ie, publications, confer-
ence proceedings). Changes to this model include view-
ing communities and stakeholders in the population of
focus as the primary audience. Putting the population
of focus at the center and enabling them to be the pro-
tagonists in their stories will support engagement.
There is no 1 way or approach to support antiracism dis-
semination, but to build trust, it can include sharing
findings with participants and communities through
presentations, videos, newsletters, health fairs, and
social media. Results should be shared in clear language
without jargon whilst acknowledging systemic injustices
that contribute to disparities. Researchers should also
consider if they are the best communicator of findings
or whether a colleague or community stakeholder can
best deliver the message. Other innovative options
include holding a town hall meeting, educational videos
on video-sharing platforms,65 a data walk or data
party,97 a gallery of pictures or photographs, or a com-
munity play.7 Participants or stakeholders can be
included as authors on manuscripts and can be part of
presentations. Their involvement can help ensure cul-
tural sensitivity, accurate representation, explanations
for any phenomena observed in the data from the
patient’s perspective, and improve the transparency of
research findings.Given the organizational barriers of translating pain
research findings into adoption and practice, dissemina-
tion to clinical sectors is critical. Public health research-
ers have shared numerous lessons learned regarding the
dissemination of research to clinical practice audiences.
Brownson et al. (2018) highlight that stakeholder
engagement enhances dissemination along with mes-
sages that arouse emotion and establish usefulness.21
They indicate that passive interventions are largely
unsuccessful because uptake does not happen sponta-
neously, that dissemination needs to be time-efficient,
consistent with the organization and aligned with the
skills of staff members, and our measures of academic
impact can differ significantly from the markers of
importance of clinical practice audiences.21 For pain sci-
entists, when developing dissemination materials for
clinicians and primary care providers, they could identify
and prioritize key information to increase the likelihood
of adoption. Emphasis could be placed on the accumula-
tion of pain management protocols and incorporating
the narratives of patients from racialized groups that
generally have limited dissemination into clinical prac-
tice settings. Finally, non-clinician healthcare leaders
may be most interested in interventions and services
that are cost-neutral, cost-saving, and revenue generat-
ing, but promoting equity should also be a key consider-
ation. In the wake of Derek Chauvin’s murder of George
Floyd, leaders of public and private health care institu-
tions committed to antiracism practices; the uptake of
research-tested practices promoting equity would be a
concrete way to illustrate this commitment.
Utilizing an antiracism framework, human participant
and preclinical pain researchers would have marginal-
ized groups in mind at the conceptualization stage,
rather than as an afterthought, which could lead to
inventive interpretation and dissemination. For exam-
ple, this may involve assessing existing data to identify
the racialized disparities within the healthcare systems
of interest and determining if implementation (eg,
fidelity, sustainability) outcomes for racialized groups
are similar to those of NHW patients. Instead of using
an either and/or approach, a relevant question might
be, “How do we investigate antiracism and use the
knowledge gained to develop a more responsive, equi-
table, and effective pain treatment and maximize the
likelihood of adoption into clinical practice?”Conclusion
This paper concludes our 3-part “Confronting Racism
in All Forms of Pain Research” series that highlights the
critical importance and significant benefits of adopting
an antiracism framework across all pain research disci-
plines. We have advocated for an antiracism framework
as, through direct action, it seeks to confront and eradi-
cate racism in our research practices. A shared commit-
ment to an antiracism framework requires a concerted
shift from our usual hierarchical academic and health
care practices to a rebalancing that positions communi-
ties and patients experiencing pain at the center.
924 The Journal of Pain Confronting Racism in All Forms of Pain ResearchSometimes we will fall short, but intractable problems
are not solved by any 1 person, institution, or organiza-
tion. In this spirit, we hope for future contributions to
this series and critical appraisals of our application of
the antiracism framework to drive change in pain
research and liberation from race-based trauma perpet-
uated by traditional forms of research.
People from racialized groups often have to be hyper-
vigilant of their identity, whilst that same identity means
they are ignored or invisible in many spaces. This strange
dichotomy also seems to occur in scientific inquirywithout
considering the policies and structures that drive observed
differences between White and racialized groups. To
address these inequities, self-examination and cultural
humility are essential to understand one’s position and
role within the dominant system. Additionally, there
needs to be a sustained effort to diversify research envi-
ronments and combat deep-rooted institutional racism; a
commitment to establish, develop, and maintain commu-
nity partnerships with individuals from racialized groups;
and to encourage change in our use of language and dis-
semination practices so that we do not stigmatize racial-
ized groups or reproduce oppressive forms of power.29Making these changes will increase equity in the research
process and produce generalizable data that can be credi-
bly communicated to community members and policy-
makers and, ultimately, translate into equity in pain care.Acknowledgments
In the Fall of 2020, several of our pain disparities col-
leagues joined us for a virtual think tank about antirac-
ism in pain research. We appreciate their time and
valuable insights that shaped the approach to this
series. The following individuals have provided written
approval to acknowledge their individual role in the
think tank: Emily Bartley, PhD; Amber Brooks, MD; Yeni-
sel Cruz-Almeida, PhD; Troy Dildine; Roger Fillingim,
PhD; Elizabeth Losin, PhD; Megan Miller, PhD; Chung
Jung Mun, PhD; Andrea Newman, PhD; Michael “Alec”
Owens, PhD; Fenan Rassu, PhD; Jamie Rhudy, PhD; Kee-
sha Roach, PhD; Sheria Robinson-Lane, PhD, RN; Ellen
Terry, PhD; Benjamin Van Dyke, PhD; and 4 pain dispar-
ities experts and 8 the National Institutes of Health
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