Advancing equitable pain care worldwide requires progress in low- and middle-income settings: priorities for practice, research, and policy

Equitable, high-value pain care remains out of reach for many populations worldwide, particularly for people living in low- and middle-income countries and cultural minority groups in high-income settings. Despite carrying a disproportionate burden of chronic pain, these populations remain underrepresented in high-quality pain research, underserved by existing health systems, and constrained by social, political, environmental, and commercial determinants of health. The lack of locally generated evidence forces clinicians and policymakers to rely on externally produced research that may not translate to local cultural, linguistic, or health-system contexts. This invited viewpoint synthesizes key contributors to pain inequity-including limited prioritization of chronic pain in low- and middle-income countries, underdeveloped rehabilitation capacity, poor access to essential treatments, commercial exploitation, and misalignment between culturally shaped pain beliefs and Western-derived assessment and treatment models. I highlight opportunities to strengthen equity in clinical care through improved education of health professionals and the public, culturally and linguistically responsive assessment, and contextually adapted self-management and treatment strategies. Equitable research requires standardized collection of sociodemographic variables, deliberate inclusion of underrepresented groups, and global partnerships that avoid colonizing practices. I propose principles for fair and impactful North-South collaborations focused on co-creation of research agendas, shared leadership, sustainable capacity building, and transparent governance. Advancing equitable global pain care and research will require collective action from clinicians, researchers, institutions, policymakers, journals, funders, and communities. A coordinated shift toward culturally grounded, contextually adaptable, and ethically collaborative approaches is essential to meaningfully reduce global pain disparities and ensure all individuals benefit from scientific progress.