“Pain 1993” is a nod to fashion designer Ian Connor’s motto, “Born from Pain 1993.” Ian is a longtime friend of Drake and Carti and he was previously Carti’s manager. Carti even named a song after him in 2015.

The track was revealed on June 7, 2019, by Ian on Twitter in a screenshot reading “Drake x Carti – ‘Pain 1993’ Noel Ref 1,“ with "Noel” indicating that it was engineered by OVO Noel and “Ref 1” indicating that it is the first reference of the track.

Snippets of Drake’s vocals in the reference were leaked in January 2020. Drake previewed his chorus and verse in full on April 7, 2020, on Instagram Live, asking his fans to tell Carti to release it.

On April 16, 2020, a promotional video recorded by Ian Connor and Chris Skylark and edited by Nick Dolan was previewed on the Born from Pain Twitter, also previewing the chorus and most of Drake’s verse in full quality.

On April 29, 2020, Ian Connor posted a text message from Drake reading “So proud / Pain 1993 came to life” on Twitter, implying that Carti recorded a verse for the song. The next day, the song surfaced on Shazam showing that it was given back to Drake and would be released on Dark Lane Demo Tapes.

Drake confirmed its appearance on the project two hours later on Instagram. Snippets of the full song surfaced a few hours before its release.