Variability in the pain experience and treatment among patients of different races or ethnicities has been well studied over the past half century. Despite a large body of evidence describing these differences, the importance of these differences on health and cost outcomes has not be evaluated by pharmacoeconomists and outcomes researchers. We examined the subject to identify potential reasons for the lack of pharmacoeconomics and outcomes research (PE/OR) evaluations by first, defining PE/OR, second, taking the position that race can be an important modifier of disease outcomes by pointing out some identified differences in drug responses due to biology, and third, describing how PE/OR researchers have looked at race in other disease states. Finally, we propose some theories for the lack of such evaluations in pain outcomes research including the limited availability of race and ethnicity data in secondary datasets, a lack of priority for public and private funding organizations to support this type of research, and the potential biases of researchers and funding organizations.