Introduction
Inadequate pain assessment and management can contribute to worse clinical outcomes and deepen health inequities.1 Patients with a preferred language other than English (PLOE) face significant communication barriers contributing to disparities in pain assessment and management. Previous research highlights differences in pain care based on patients’ preferred languages in trauma pain care,2 postoperative settings,3 and the emergency department.4 Qualitative findings reveal that language discordance between patients and providers may contribute to misinterpretations of pain symptoms and misaligned treatment expectations.5
Methods
A comprehensive literature search was conducted using PubMed, Embase, and Scopus databases. The search strategy “(tool OR training OR assessment OR management OR interpreter OR scale OR strategy OR intervention) AND (limited English proficiency OR linguistic OR language barrier) AND (pain OR analgesia)” yielded 2930 non-duplicate articles.
After title and abstract screening, 130 articles were selected for full-text review. 7 articles were selected based on the inclusion criteria of being a full-length primary article relevant to clinical medicine, including a pain care intervention, tool, or strategy, and involving an adult population with PLOE. Key data were extracted from each article, including study design, patient population, location of study, pain condition or type, and relevant findings (Table 1).
Results
Bedside interpreter phones and consistent access to professional interpreters significantly enhanced real-time communication and pain assessment.6,7 Visual tools like the Pictorial Pain Interference Questionnaire8 and digital pain drawings9 aided symptom understanding across language barriers. Neural machine translation apps, such as Google Translate, showed promise in assessing pain in perioperative settings.10 Provider Spanish fluency correlated with better adherence to pain management practices.11 Additionally, language-concordant outreach, including pre-visit calls in the patients preferred language, improved pain management appointment attendance.12 Widespread implementation of these strategies has the potential to advance health equity by reducing language-related disparities in pain care.
Conclusions
This narrative review identified interpreter use, adapted visual pain assessment tools, technological advancements, provider language competence, and language-concordant patient outreach as key interventions in bridging communication gaps for patients with PLOE. Implementation of these tools can improve patient-provider communication and decrease inequities in pain management.
Table
| Title | Author | Year | Methodology | Population | Location of Study | Pain Type | Relevant Findings |
|---|---|---|---|---|---|---|---|
| Hospital discharge preparedness for patients with limited English proficiency: a mixed methods study of bedside interpreter-phones | Lee et al.1 | 2025 | Focus Groups | Twenty resident physicians and fourteen nurses | California, USA | Peri-operative, acute | Providers viewed bedside interpreter phones as particularly useful by when assessing pain management |
| The effect of initiatives to overcome language barriers and improve attendance: A cross- sectional analysis of adherence in an inner city chronic pain clinic | Andreae et al.2 | 2017 | Retrospective cross-sectional analysis | 3035 patients with a scheduled first appointment at an adult outpatient pain center from March 2012 to March 2014 | Bronx, New York, USA | Chronic | Receiving a pre-clinic appointment phone call in Spanish was statistically significantly associated with increased odds of arriving to an initial pain clinic appointment |
| Use of Neural Machine Translation Software for Patients With Limited English Proficiency to Assess Postoperative Pain and Nausea | Kapoor et al.3 | 2022 | Cohort study | Spanish-speaking patients in the post anesthesia care unit (PACU) | Texas, USA | Peri-operative, acute | More than 90.0% of patients were able to communicate their pain using a free multilingual neural machine translation service (Google Translate conversation mode). Most (96.7%) were able to successfully answer all questions, with no patients needing standard translation services. 96.6% of patients reported being “satisfied” or “very satisfied” with the ability of the application to assess their symptoms |
| Patient-reported quality of pain treatment and use of interpreters in Spanish-speaking patients hospitalized for obstetric and gynecological care | Jimenez et al.4 | 2012 | Secondary analysis of two cross-sectional surveys. | One hundred and eighty-five Latino female patients hospitalized for obstetric and gynecological care who required interpreter services | United States | Obstetric and gynecological | Patients who always received interpreters were more likely to report higher levels of pain control (P=0.02), timely pain treatment (P=0.02), and greater perceived provider helpfulness to treat their pain (P=0.005), compared with patients who did not always receive interpreters. |
| Psychometric Properties of the Pictorial Pain Interference Questionnaire for Assessing Functional Interference in Chronic Low Back Pain | Moreno-Ligero et al.5 | 2024 | Cross-sectional | Adult patients with CLBP being observed by the Rehabilitation Unit of the Hospital Puerta del Mar in Cádiz (Spain) | Spain | Chronic lower back pain | Validates the PPIQ in people with chronic lower back pain, establishing it as a measurement tool usable for assessing functional interference due to pain |
| Clinical utility of digital pain drawings captured by people living with musculoskeletal pain conditions: a qualitative study | Ali et al.6 | 2025 | Narrative study | Three general practitioners, five rheumatology healthcare professionals, four physiotherapists, two pain consultants and one rheumatology nurse | United Kingdom | Chronic | Healthcare professionals thought longitudinally collected digital pain drawings had potential to enrich patient-provider communication, particularly for patients with language barriers, by describing changes in their pain experience. |
| Health care provider perceptions of pain treatment in Hispanic patients | Chiauzzi et al.7 | 2011 | Cross-sectional survey | One hundred eighty-seven health professionals | United States | Unspecified | Provide fluency in Spanish and experience with Spanish-speaking pain patients has a strong effect on the use of established pain treatment practices |
Table 1 references:
Lee JS, Nápoles A, Mutha S, et al. Hospital discharge preparedness for patients with limited english proficiency: A mixed methods study of bedside interpreter-phones. Patient education and counseling. 2018;101(1):25–32. https://dx.doi.org/10.1016/j.pec.2017.07.026. doi: 10.1016/j.pec.2017.07.026.
Andreae MH, White RS, Chen KY, Nair S, Hall C, Shaparin N. The effect of initiatives to overcome language barriers and improve attendance: A cross-sectional analysis of adherence in an inner city chronic pain clinic. Pain medicine (Malden, Mass.). 2017;18(2):265–274. https://www.ncbi.nlm.nih.gov/pubmed/28204760. doi: 10.1093/pm/pnw161.
Kapoor R, Corrales G, Flores MP, Feng L, Cata JP. Use of neural machine translation software for patients with limited english proficiency to assess postoperative pain and nausea. JAMA Network Open. 2022;5(3):e221485. http://dx.doi.org/10.1001/jamanetworkopen.2022.1485. doi: 10.1001/jamanetworkopen.2022.1485.
Jimenez N, Moreno G, Leng M, Buchwald D, Morales LS. Patient-reported quality of pain treatment and use of interpreters in spanish-speaking patients hospitalized for obstetric and gynecological care. J GEN INTERN MED. 2012;27(12):1602–1608. https://link.springer.com/article/10.1007/s11606-012-2154-x. doi: 10.1007/s11606-012-2154-x.
Moreno-Ligero M, Dueñas M, Failde I, Del Pino R, Coronilla MC, Moral-Munoz JA. Psychometric properties of the pictorial pain interference questionnaire for assessing functional interference in chronic low back pain. Archives of physical medicine and rehabilitation. 2024;105(10):1870–1879. https://dx.doi.org/10.1016/j.apmr.2024.05.029. doi: 10.1016/j.apmr.2024.05.029.
Ali SM, Elsayed S, Lee RR, et al. Clinical utility of digital pain drawings captured by people living with musculoskeletal pain conditions: A qualitative study. British journal of pain. 2025:20494637251343227. https://www.ncbi.nlm.nih.gov/pubmed/40386250. doi: 10.1177/20494637251343227.
Chiauzzi E, Black RA, Frayjo K, et al. Health care provider perceptions of pain treatment in hispanic patients. Pain practice. 2011;11(3):267–277. https://api.istex.fr/ark:/67375/WNG-DRZ9WP8G-0/fulltext.pdf. doi: 10.1111/j.1533-2500.2010.00421.x.
References
1. Baratta JL, Schwenk ES, Viscusi ER. Clinical consequences of inadequate pain relief: Barriers to optimal pain management. Plastic and reconstructive surgery (1963). 2014;134(4S-2):15S–21S. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00006534-201410002-00005. doi: 10.1097/PRS.0000000000000681.
Schwartz HEM, Matthay ZA, Menza R, et al. Inequity in discharge pain management for trauma patients with limited english proficiency. The journal of trauma and acute care surgery. 2021;91(5):898–902. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=01586154-202111000-00020. doi: 10.1097/TA.0000000000003294.
Joo H, Nguyen K, Kolodzie K, Chen L, Kim M, Manuel S. Differences in acute postoperative opioid use by english proficiency, race, and ethnicity after total knee and hip arthroplasty. Anesthesia and analgesia. 2025;140(1):155–164. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&DO=10.1213/ANE.0000000000007068. doi: 10.1213/ANE.0000000000007068.
Wolgemuth T, Gauf A, Monti D, Amin D, Geynisman-Tan J. Patient language and differences in administration of analgesia for pelvic pain. Women's health issues. 2025;35(4):261. https://dx.doi.org/10.1016/j.whi.2025.05.006. doi: 10.1016/j.whi.2025.05.006.
Bifulco L, Almonte S, Sosa S, Etemad L, Ruiz D, Blankson ML. A qualitative assessment of factors contributing to spanish-speaking federally qualified health center patients’ chronic pain experiences. PloS one. 2023;18(5):e0285157. https://www.ncbi.nlm.nih.gov/pubmed/37200248. doi: 10.1371/journal.pone.0285157.
Lee JS, Nápoles A, Mutha S, et al. Hospital discharge preparedness for patients with limited english proficiency: A mixed methods study of bedside interpreter-phones. Patient education and counseling. 2018;101(1):25–32. https://dx.doi.org/10.1016/j.pec.2017.07.026. doi: 10.1016/j.pec.2017.07.026.
Jimenez N, Moreno G, Leng M, Buchwald D, Morales LS. Patient-reported quality of pain treatment and use of interpreters in spanish-speaking patients hospitalized for obstetric and gynecological care. J GEN INTERN MED. 2012;27(12):1602–1608. https://link.springer.com/article/10.1007/s11606-012-2154-x. doi: 10.1007/s11606-012-2154-x.
Moreno-Ligero M, Dueñas M, Failde I, Del Pino R, Coronilla MC, Moral-Munoz JA. Psychometric properties of the pictorial pain interference questionnaire for assessing functional interference in chronic low back pain. Archives of physical medicine and rehabilitation. 2024;105(10):1870–1879. https://dx.doi.org/10.1016/j.apmr.2024.05.029. doi: 10.1016/j.apmr.2024.05.029.
Ali SM, Elsayed S, Lee RR, et al. Clinical utility of digital pain drawings captured by people living with musculoskeletal pain conditions: A qualitative study. British journal of pain. 2025:20494637251343227. https://www.ncbi.nlm.nih.gov/pubmed/40386250. doi: 10.1177/20494637251343227.
Kapoor R, Corrales G, Flores MP, Feng L, Cata JP. Use of neural machine translation software for patients with limited english proficiency to assess postoperative pain and nausea. JAMA Network Open. 2022;5(3):e221485. http://dx.doi.org/10.1001/jamanetworkopen.2022.1485. doi: 10.1001/jamanetworkopen.2022.1485.
Chiauzzi E, Black RA, Frayjo K, et al. Health care provider perceptions of pain treatment in hispanic patients. Pain practice. 2011;11(3):267–277. https://api.istex.fr/ark:/67375/WNG-DRZ9WP8G-0/fulltext.pdf. doi: 10.1111/j.1533-2500.2010.00421.x.
Andreae MH, White RS, Chen KY, Nair S, Hall C, Shaparin N. The effect of initiatives to overcome language barriers and improve attendance: A cross-sectional analysis of adherence in an inner city chronic pain clinic. Pain medicine (Malden, Mass.). 2017;18(2):265–274. https://www.ncbi.nlm.nih.gov/pubmed/28204760. doi: 10.1093/pm/pnw161.