The role of race and neighborhood socioeconomic status on pain persistence

Abstract

Chronic pain negatively impacts quality of life (QOL). Outcomes are worse for people who do not get a break from their pain (e.g. pain maintains a consistently high level that is not alleviated through attempts to reduce it). We speculated that neighborhood socio-economic status (nSES) contributes to variability in the chronic pain experience. We recruited 183 black and white patients, age and gender matched, presenting for chronic pain management at a tertiary pain care center (92% response rate, 50% white, 63% female). Participant addresses were matched to US Census data using geocoding software and the percentage of people in census tracts with < high school education, percentage living below the poverty line, and percentage of the labor force not employed were calculated. Participants (18 to 50 years) meeting chronic pain criteria (≥6 months consistent, non-cancer pain) completed a survey regarding their pain experience. Outcomes were compared by race and nSES variables. Blacks and people in less educated, poorer, and less employed neighborhoods had more things that made their pain worse (e.g., weather, walking), fewer things that made it better (e.g., relaxation, ice), less adequate pain management, and scored their ‘pain at least’ higher than whites or people in higher SES neighborhoods (p<.01). Variables were explored to examine which variables most strongly predicted previously established differences in disability and affective distress experienced by blacks and poor who have chronic pain. Our findings help clarify the mechanisms by which people with the same pain severity might have differing pain related outcomes and support the need to assess nSES when managing pain.