A landmark report from the Institute of Medicine (IOM) in 2003 documented that from the simplest to the most technologically advanced diagnostic and therapeutic interventions, African American (or black) individuals and those in other minority groups receive fewer procedures and poorer-quality medical care than white individuals. 1 These differences existed even after statistical adjustment for variations in health insurance, stage and severity of disease, income or education, comorbid disease, and the type of health care facility. Very limited progress has been made in reducing racial/ethnic disparities in the quality and intensity of care. 2 The IOM report concluded that multiple factors contribute to racial disparities in medical care and that unconscious bias by health care professionals contributes to deficits in the quality of care. This Viewpoint discusses the potential contribution of societal racial bias to disparities in health care and health status.

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Although pain is a widespread problem, studies have found that chronic disease, psychological distress, Medicaid insurance, and lower education levels are associated with higher incidences of severe pain [2]. Undertreating pain can lead to adverse outcomes, including elevated heart rates after surgery and increased risk of myocardial infarction, ischemic stroke, and bleeding events as a result of elevated systemic vascular resistance and elevated levels of catecholamines [2]. Other consequences of uncontrolled pain include reduced mobility, loss of strength, sleep disturbances, immune system impairment, increased susceptibility to disease, and medication dependence [3].Despite the availability of effective pharmacologic and nonpharmacologic interventions and methods to manage pain, there is a significant gap between the evaluation and treatment of pain in white people and its evaluation and treatment in African American and Hispanic people [4]. Differences in pain treatment may be due to differences in needs-e.g., resulting from genetic differences-or to inequitiesunfair differences in access or opportunity, e.g., unavailability of opioids in a neighborhood [2]. Another cause of differences in treatment may be a lack of awareness among clinicians and trainees of evidence-based guidelines. Defining PainThe American Academy of Pain Medicine classifies pain as acute or chronic. In acute pain, a "one-to-one relationship exists between injury and pain," and the "pain is frequently short-lived and self-limiting" [5]. However, the pain "can become persistent and intractable if the underlying disease process or injury is chronic or incurable, or if the activation of pain is unavoidable, as in pain caused by movement or weight bearing in injuries of the spine or in diseases such as arthritis" [5]. Chronic pain is defined as pain that persists longer than three months [5]. Pain can be managed with a range or combination of treatments such as nonsteroidal antiinflammatories (NSAIDs) and other nonopioid medications, physical therapy, psychological interventions, alternative medicine, referral to a specialist, or opioids. Pharmacogenomics and PainA review of the literature on the influence of race or ethnicity on the pharmacokinetics of analgesics found that there may be differences in bioavailability, hepatic metabolism, renal secretion, protein binding, and distribution

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