How does the opioid crisis influence disparities in the treatment of pain? The experience of pain is subjective and therefore necessarily based on self-report. As such, clinical interactions around its treatment can lead to disparities in care. The opioid crisis has exacerbated current treatment disparities, resulting in prescribing patterns influenced by race and class. This study shows how these disparities unfold by investigating how patient-provider interactions reflect and often reinforce broader social inequities. By describing the structural factors that impact the pain experience and how power circulates through the clinical encounter, we contribute to understandings of how social processes influence the provision of medical care to patients experiencing pain.