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Antiracism CoaliTION in Pain Research (ACTION-PR): Guiding Principles for Equity in Reporting

Published:November 29, 2022DOI:https://doi.org/10.1016/j.jpain.2022.11.002

      Highlights

      • Pain inequities exist for racialized and minoritized groups
      • Antiracism CoaliTION in Pain Research are committed to equity in pain science
      • Transparency and equity in manuscript reporting are imperative
      Over the past 2 years, the systematically disproportionate burden of Covid-19 on people from racialized and minoritized communities has glaringly illustratedthe longstanding oppression, discrimination, bias, and racism-based violence faced by excluded communities worldwide. Ongoing legacies include the murder of Black people by law enforcement in the US, anti-immigration policies in Europe, the persecution of Uighur Muslims in China and women and their allies in Iran, and the discovery of hundreds of unmarked graves of Indigenous children in Canada. Long overdue conversations about the mistreatment of minoritized communities have ignited global discourse on structural injustices and have spurred the research community to engage in a critical examination of racism, oppression, and biases in our fields – all pointing to the urgent need for change.

      American Psychological Association: APA apologizes for longstanding contributions to systemic racism [Internet]. 2021. Available at: https://www.apa.org/news/press/releases/2021/10/apology-systemic-racism. Accessed January 10, 2022.

      As one of the gatekeepers of knowledge, scholarly and scientific journals have moved towards addressing equity, diversity, and inclusion (EDI) issues, including transparency in reporting,
      • Flanagin A
      • Frey T
      • Christiansen SL
      • Bauchner H
      The reporting of race and ethnicity in medical and science journals: Comments invited.
      ,
      • Palermo TM
      • Alderfer M
      • Boerner KE
      • Hilliard ME
      • Hood AM
      • Modi AC
      • Wu YP
      Editorial: Diversity, equity, and inclusion: Reporting race and ethnicity in the Journal of Pediatric Psychology.
      ,
      • Rubin E
      Striving for diversity in research studies.
      and purposively expanding diversity with the inclusion of women and people from racialized groups to editorial boards and peer review panels.
      • Mindt MR
      • Hilsabeck RC
      • Olsen JP
      • Savin MJ
      • Crook CL
      • Suchy Y
      Advancing science through diversity and inclusion in the editorial process: A case study.
      In pain treatment, care, and research, racism manifests in numerous insidious ways.
      • Mathur VA
      • Trost Z
      • Ezenwa MO
      • Sturgeon JA
      • Hood AM
      Mechanisms of injustice: What we (do not) know about racialized disparities in pain.
      For decades, pain inequities have been documented for racialized and minoritized groups,
      • Booker SQ
      • Bartley EJ
      • Powell-Roach K
      • Palit S
      • Morais C
      • Thompson OJ
      • Cruz-Almeida Y
      • Fillingim RB
      The imperative for racial equality in pain science: A way forward.
      ,
      • Campbell CM
      • Edwards RR
      Ethnic differences in pain and pain management.
      along with non-inclusive research practices,
      • Letzen JE
      • Mathur VA
      • Janevic MR
      • Burton MD
      • Hood AM
      • Morais CA
      • Booker SQ
      • Campbell CM
      • Aroke EN
      • Goodin BR
      • Campbell LC
      • Merriweather EN
      Confronting racism in all forms of pain research: Reframing designs.
      and a lack of transparency in reporting and dissemination of findings.
      • Hood AM
      • Booker SQ
      • Morais CA
      • Goodin BR
      • Letzen JE
      • Campbell LC
      • Merriweather EN
      • Aroke EN
      • Campbell CM
      • Mathur VA
      • Janevic MR
      Confronting racism in all forms of pain research: A shared commitment for engagement, diversity, and dissemination.
      ,
      • Janevic MR
      • Mathur VA
      • Booker SQ
      • Morais C
      • Meints SM
      • Yeager KA
      • Meghani SH
      Making pain research more inclusive: Why and how.
      Thus, to promote EDI and confront racism in pain science, the Antiracism CoaliTION in Pain Research (ACTION-PR; also informally known as the Pain Justice League)
      • Morais CA
      • Aroke EN
      • Letzen JE
      • Campbell CM
      • Hood AM
      • Janevic MR
      • Mathur VA
      • Merriweather EN
      • Goodin BR
      • Booker SQ
      • Campbell LC
      Confronting racism in pain research: A call to action.
      was formed in September 2020. ACTION-PR is an independent group of scientists committed to EDI comprised of researchers with expertise in pain inequities, clinical and population pain research, basic science, and translational research (see authors on this paper) who are committed to implementing antiracism principles in pain research and are guided by cultural humility – a lifelong commitment to self-evaluation and critique to redress power imbalances.
      • Greene-Moton E
      • Minkler M
      More recently, ACTION-PR has expanded to include more basic pain scientists and additional members who reside outside of the US to better reflect the global reach of oppression and colonization.
      Thus far, ACTION-PR's collective efforts include facilitating virtual group think tanks with 39 pain scientists, co-authoring the 3-part Confronting Racism in Pain Research series
      • Hood AM
      • Booker SQ
      • Morais CA
      • Goodin BR
      • Letzen JE
      • Campbell LC
      • Merriweather EN
      • Aroke EN
      • Campbell CM
      • Mathur VA
      • Janevic MR
      Confronting racism in all forms of pain research: A shared commitment for engagement, diversity, and dissemination.
      ,
      • Letzen JE
      • Mathur VA
      • Janevic MR
      • Burton MD
      • Hood AM
      • Morais CA
      • Booker SQ
      • Campbell CM
      • Aroke EN
      • Goodin BR
      • Campbell LC
      • Merriweather EN
      Confronting racism in all forms of pain research: Reframing designs.
      ,
      • Morais CA
      • Aroke EN
      • Letzen JE
      • Campbell CM
      • Hood AM
      • Janevic MR
      • Mathur VA
      • Merriweather EN
      • Goodin BR
      • Booker SQ
      • Campbell LC
      Confronting racism in pain research: A call to action.
      and presenting at webinars, grand rounds, and conferences (eg, US Association for the Study of Pain) about the implementation of an antiracism framework in pain science and clinical care for audiences of pain researchers, clinicians, and people with lived experience of pain. In the fall of 2020, ACTION-PR began to discuss ways to promote principles of justice, equity, and diversity in scientific publishing practices in pain research. Pain-focused journals can lead in dismantling the barriers, systems, and structures that uphold pain science injustice
      • Mathur VA
      • Trost Z
      • Ezenwa MO
      • Sturgeon JA
      • Hood AM
      Mechanisms of injustice: What we (do not) know about racialized disparities in pain.
      and limit the capacity of pain science to address pain inequities. Through our conversations, the need to enhance equity in reporting pain science became imperative.
      Peer review is an intrinsically subjective evaluation system utilizing researcher expertise to uphold standards of rigor, reproducibility, validity, objectivity, novelty, and integrity. Our peer review decisions are formed from the intersection of our training background (often consciously) and our cultural worldview (often unconsciously). For this reason, it is important for EDI principles to be integrated into scientific practices and during the peer review process. Formal editorial guidance and policy will help authors, editors, and reviewers align their equity values with scholarly practices and become change agents in this effort. Using structured guidelines would help authors and reviewers enhance research products that promote equity via increasing precision, specificity, and clarity of reporting – all hallmarks of scientific rigor. Therefore, ACTION-PR created the Inclusion, Diversity, Equity, Antiracism, and Accessibility (IDEAA) guidelines to increase transparency and equity in manuscript reporting.
      The development of the IDEAA guidelines used a reflexive process grounded in bias reduction, antiracism scholarship (eg, diversity science, sociology, psychology, etc.), and equity values. We intentionally focused on the experiences of people living with pain who, due to societal oppression (eg, from racism, colorism, sexism, ageism, classism, transphobia, ableism, etc.), have additional burdens on physiological processes, well-being, and ability to receive adequate pain care. Using an iterative approach, ACTION-PR first shared ideas for the guidelines with The Journal of Pain's former editor-in-chief (Dr. Mark Jensen). To facilitate in-depth discussions, a smaller group of ACTION-PR members (AMH, CAM, VAM, ENM, JEL) began meeting monthly with Dr. Jensen and The Journal of Pain's current editor-in-chief (Dr. Tonya Palermo) to partner on refining the IDEAA guidelines and discussing implementation. Feedback was then sought and incorporated from Associate Editors and members of The Journal of Pain editorial board, other editors-in-chief of pain journals, and people with lived experience of pain. For example, people with lived experience of pain suggested that the IDEAA guidelines should be in accessible formats (eg, for people who are blind/people with vision impairments). Therefore, ACTION-PR members are actively working to make these available. Beginning in January 2023, The Journal of Pain will be the first pain journal to adopt the IDEAA guidelines (see Palermo, 2023 in this issue).
      • Palermo TM
      Editorial: introducing new reporting guidelines to address inclusion, diversity, equity, antiracism, and accessibility: Implementation at the Journal of Pain.
      In building a pain research community that values EDI guiding principles and aims to improve research and reporting practices, we hope that other pain journals will also choose to incorporate the IDEAA guidelines.
      The goal of the IDEAA guidelines is to have authors increase equity in reporting whilst reflecting on how EDI principles were embedded in their work, to assist reviewers in identifying where papers can be strengthened, and to have the resulting manuscript transparently disseminate pain research. As IDEAA guidelines become standard practice for rigorous reporting of pain science, the hope is that the guiding EDI and accessibility principles will become integral to the research process from the point of study conceptualization through to research dissemination, community uptake, and policy-making.
      With any systemic publishing change, however, there are likely concerns related to an increased burden on authors and reviewers, a shortage of time for editors, and insufficient awareness and training. Nevertheless, successful prior changes aimed at improving the quality and equity focus of published articles make us confident that the IDEAA guidelines will become a meaningful part of the peer review process. For example, the Sex and Gender Equity in Research guidelines have demonstrated that these types of requirements can be embedded into the editorial and peer reviewer instructions across hundreds of journals.
      • Peters SAE
      • Babor TF
      • Norton RN
      • Clayton JA
      • Ovseiko P V
      • Tannenbaum C
      • Heidari S
      Fifth anniversary of the Sex And Gender Equity in Research (SAGER) guidelines: Taking stock and looking ahead.
      The IDEAA guidelines were created to eliminate research practices that uphold social privilege and biased assumptions that innate characteristics drive observed differences in pain outcomes for racialized and marginalized groups, thereby cultivating a pain research landscape across the translational continuum that helps reduce inequities. ACTION-PR recognizes that some IDEAA guidelines will evolve (eg, language styles) and are committed to periodic reviews, improvements (eg, language translations), and updates as our understanding develops. To improve the lives of all people with lived experience of pain, equity in manuscript reporting is required to drive structural changes that meaningfully advance pain research and its global dissemination.

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