Disparities In Pain Research Articles (Page 1)

Underreporting of Pain for Short-Stay Nursing Home Residents in the Minimum Data Set 3.0?: Staff-Report, Self-Report, and the Role of Cognitive Impairment and Racial/Ethnic Identity.

Welfare policies, joint pain prevalence and educational gaps in 50 U.S. states from 2011 to 2021: A fixed effects analysis.

Making underrepresented pain visible: Chronic pain disparities among immigrant adolescents in 30 European countries.

Pain disparities among Medicaid beneficiaries with chronic low back pain: The differential role of psychological distress.

Social determinants of health have been associated with knee osteoarthritis (OA) symptoms. However, there is a dearth of research on the influence of social determinants of health on knee OA among Hispanics despite Hispanics being disproportionately impacted by racial/ethnic disparities in pain and function. Thus, we sought to investigate the relations of social determinants of health to pain and function in individuals with knee OA in a Hispanic-dominant community. We included participants residing in El Paso, Texas, a major Hispanic community in the US. We evaluated relations of income level, education level and perceived discrimination to The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain, quantitative sensory testing (QST) measures of pressure pain threshold (PPT), temporal summation (TS) and conditioned pain modulation (CPM), and WOMAC function using linear or logistic regression models adjusting for age, sex and BMI. Fifty-nine participants with knee OA were included (76% Hispanic). Higher income and education levels were associated with less knee pain and better function. Higher income and education levels had non-significant trends toward associations with non-facilitated TS and higher PPT, respectively. In contrast, perceived discrimination was not associated with any of the outcomes. We found that income and education levels were associated with pain and function and showed non-significant associations with central pain sensitization assessed by PPT and TS. Perceived discrimination was not associated with any outcome. These findings underscore the importance of social determinants of health in precision pain management for Hispanic individuals with knee OA.

Socioeconomic and structural factors remain underexplored in five decades of pain disparities research.

Pain phenotype trajectories and links to family relationship quality among black older adults.

This study tests novel research questions regarding Black-White disparities in bodily pain and goal-striving stress (GSS). A largely overlooked chronic stressor, GSS measures the psychosocial strains of blocked opportunity and dashed aspirations. We address our research questions among a socioeconomically diverse sample of Black and White working-age adults from Nashville, Tennessee (2011-2014; n = 1,252). We find that White adults with low socioeconomic status (SES) report the highest levels of GSS and pain, relative to their Black and high-SES White peers. Moreover, GSS predicts higher pain levels only among low-SES White adults. These patterns hold regardless of other sociodemographic characteristics, occupational hazards, chronic illnesses, stressful life events, and experiences with discrimination. Our findings have critical implications for researchers, clinicians, and policymakers concerned with rising rates of pain and opioid abuse among midlife adults in the United States. We discuss these implications and outline several avenues for future research.

BackgroundChronic pain is partly maintained by the sympathetic nervous system, whose activity is best measured by muscle sympathetic nerve activity (MSNA). MSNA responses to acute pain have been thoroughly investigated, whereas MSNA responses to longer-lasting pain are poorly understood. Therefore, this study examined the relationship between pain ratings and peroneal MSNA during a tonic cold pressor test (CPT) in male and female participants.MethodsWe obtained MSNA measures during a 6 min CPT in 18 young adult (20–33 years) men and women. Verbal pain ratings (0–10) and autonomic outcomes (heart rate [HR], mean arterial blood pressure [MAP], and MSNA) were assessed simultaneously at multiple time points across the CPT.ResultsPain, HR, and MAP increased in the initial 30s in both sexes. Females increased their MSNA burst frequency (BF) to a greater extent than males. Across the full CPT we observed a positive relationship between pain and HR in males, a positive relationship between pain and MSNA BF in females, and a negative relationship between pain and MSNA burst amplitude in females.ConclusionsOverall, males displayed a strong relationship between tonic pain and HR, an index of parasympathetic activity, whereas females displayed strong and offsetting relationships between tonic pain and purely sympathetic MSNA variables. These observations suggest sex differences in autonomic mechanisms during tonic pain, which may have relevance to ongoing efforts to modulate pain via manipulations of the autonomic nervous system, as well as sex/gender disparities in chronic pain prevalence.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13293-025-00743-2.

ObjectiveThe rapid growth in the cancer survivor population in Chile and Latin America raises new challenges in addressing their care needs. This study assesses the health status and compares the quality of care and quality of life in cancer survivors at a primary care network and a private cancer centre in Santiago, Chile.DesignRetrospective cohort study.SettingThree primary care clinics and one cancer centre in Chile.ParticipantsAll breast and colorectal cancer patients identified from a primary care retrospective cohort of 61 174 were followed from 2018 to 2023 and compared with an equivalent sample of patients from a university cancer centre identified during the same period.Outcome measuresQuality of care was assessed based on American Cancer Society standards, while quality of life was measured using the EuroQol 5 Dimensions-5 Levels survey instrument.ResultsA total of 420 cancer survivors participated in the study; 208 from primary care and 212 from the cancer centre. All participants received substandard care. Patients in primary care had lower educational levels and higher rates of comorbidity. They reported a lower quality of life score (72.22 vs 78.43, p<0.001), a higher prevalence of chronic pain (37.02% vs 25.6%, p=0.016) and more severe mental health symptoms (19.89% vs 10.05%, p=0.03). Differences in educational level and cancer stage at diagnosis explained the observed disparities in chronic pain and mental health disorders between the two populations. Primary care patients received more psychosocial care (OR=2.29; 95% CI: 1.55 to 3.39), cardiovascular assessment (OR=2.66; 95% CI:2.17 to 3.26) and psychosocial evaluations (OR: 9.07; 95% CI:4.75 to 17.32).ConclusionCancer survivors face a significant disease burden and receive substandard care in Chile. As the primary source of care for this population, primary care is challenged to better integrate with speciality care to develop an effective shared care model for cancer survivors.

Native Americans (NAs) experience higher rates of chronic pain than other U.S. racial/ethnic groups. Sleep and pain share a bidirectional relationship, but sleep impacts pain more than the reverse. NAs experience high rates of sleep problems; thus, sleep may contribute to the NA pain disparity. To date, there have been no intensive longitudinal assessments of sleep and pain to assess whether sleep-pain temporal relationships differ across racial/ethnic groups, including NAs. To address this research gap, a secondary analysis of a clinical trial of a mobile health intervention for anxiety and/or depression sample was conducted. NA (n = 199), White (n = 205), Black (n = 198), and Hispanic adults (n= 199) completed ecological momentary assessments (EMAs) of daily sleep quality, sleep duration, and morning and evening pain intensity for 6-months. Dynamic structural equation modeling was used to assess cross-lagged, temporal relationships between sleep and pain, while controlling potential confounds. As expected, there was a reciprocal sleep-pain relationship; lower sleep quality was associated with higher next-morning pain and higher pain was associated with lower next-day sleep quality. The sleep to pain path was stronger than the reverse. Evening pain was also associated with next-night sleep quality. Sleep duration was not temporally related to pain. There was a stronger sleep quality-pain association in NAs compared to Black participants, but no other racial/ethnic difference was significant. This is the first study to show that sleep-pain relationships extend to NAs and other minoritized groups, but poor sleep may not fully account for NA pain disparities.

IntroductionResearch highlights racialized inequities in pain and pain care, yet the experiences of youth–particularly in Europe–remain largely understudied. The current study addressed this gap by examining differences in perceived racialized discrimination in pain care and pain outcomes (i.e., pain intensity over the past two weeks and six months, pain frequency over the past six months, and pain tolerance) among Black/Brown and White youth in Belgium. Additionally, we explored whether perceived racialized discrimination mediated the relationship between racialized identity and pain outcomes.MethodsSeventy-six youth (52 girls, 17 boys, 2 non-binary individuals) aged 8-17 (Mage = 15.17; SDage = 2.48) completed a cold pressor task to assess pain tolerance. Participants also reported their experiences of racialized discrimination in pain care, their pain intensity over the past two weeks and six months, and their pain frequency over the past six months.ResultsResults indicated that Black/Brown youth reported greater perceived racialized discrimination in pain care and demonstrated lower pain tolerance than White youth. No significant group differences were observed for the other three pain outcomes. Perceived racialized discrimination in pain care only mediated the relationship between racialized identity and pain intensity over the past two weeks.DiscussionThese findings suggest that racialized disparities in pain and pain care exist among youth living in Belgium. However, given the relatively small sample size, the results should be interpreted with caution. Additional research on racialized disparities in pain and pain care among youth using larger and more diverse samples is warranted.

Emerging approaches to addressing longstanding inequities: Insights from the Journal of Pain special issue on pain disparities

Social disparities in pain.

Abstract Chronic pain is a global epidemic that disproportionately affects Black, Indigenous, and other people of color as well as individuals of lower socioeconomic status. Unfortunately, the mechanisms that cause and sustain disparities in pain outcomes remain underexamined. This review highlights recent insights into epigenetics as a uniquely suited biological mechanism linking environmental stressors and pain disparities. Emerging evidence suggests that epigenetic modification of genes in pathways involved in stress dysregulation and neuroinflammation may play a central role in racial pain disparities and internalized stigma. These findings indicate that differential environmental exposure (ie, chronic stress) induces epigenetic changes (mediators) that explain pain disparities. Another putative mechanism by which differential epigenetic modifications contribute to pain disparities is epigenetic age acceleration. Emerging evidence suggests that epigenetic age acceleration mediates the relationship between lower socioeconomic status (household income, food insecurity, and neighborhood deprivation) and worse pain outcomes. Epigenetic modifications are dynamic and reversible, leaning toward pharmacological and nonpharmacological interventions. Logically, these will contribute to tailored interventions for pain management and equity in pain management. Finally, we cannot ignore that social and structural forces are the root causes of pain disparities. Thus, there is a need for policy changes addressing these forces.

Gender discrimination is associated with greater chronic pain interference among women.

Background/Objectives: In the United States, maternal morbidity is 2-3 times higher than in other high-income nations and continues to rise among non-White women. One potential driving factor is whether labor and childbirth pain are assessed and addressed in a timely and effective manner. Pain during labor and childbirth can be symptomatic of maternal morbidity (e.g., pelvic pain, bleeding, high blood pressure, cardiovascular issues) and/or an independent predictor of adverse postpartum outcomes (e.g., chronic postpartum pain, postpartum depression). Methods: Since racial and ethnic disparities in pain reporting and treatment are well documented in other settings-such as chronic pain conditions, pregnancy-related pain, and postpartum care-we hypothesize that similar disparities persist during labor and delivery. In this manuscript, we evaluate differences in pain reporting and provider treatment response (or lack thereof) based on self-reported race and ethnicity during childbirth admission. Results: In a large, representative sample of women giving birth at a large hospital system (N = 46,671), we assessed race- and ethnicity-related disparities in pain reporting, evaluation, and treatment. There are racial disparities in the frequency of pain assessments, values of pain ratings, and delivery of pharmacological vs. non-pharmacological treatment. Conclusions: A large-scale investigation into racial and ethnic differences in pain assessment, reporting, and treatment during childbirth may help identify mechanisms that mitigate disparities in maternal morbidity and mortality.

Chronic pain disproportionately affects Black and Indigenous people and other people of color (BIPOC). Disparities may be related to increased chronic stress due to discrimination, trauma exposure, and social determinants of health (SDoH). Using data from families (n = 1307) in the family matters study (collected 2017-2019), a secondary data analysis explored SDoH of baseline pain severity and change in pain at 18months, and the moderating effects of childhood maltreatment and discrimination on SDoH-pain relationships. General estimating equations (GEE) modeling was used. Childhood maltreatment was associated with higher baseline pain severity, and discrimination was the strongest correlate of worse pain 18months later. Childhood maltreatment exacerbated risk for higher pain severity for women, individuals under the federal poverty line, and individuals living in areas with low financial privilege. Discrimination increased risk for higher baseline pain for Black and Latinx individuals. Discrimination and traumatic event exposure may be important contributors to BIPOC pain disparities. Pain interventions may benefit from additional attention to the toll of oppressive systems and chronic stressors on BIPOC health.

Country-level Gender Inequality, Intimate Partner Violence, and Sex Disparities in Adolescent Chronic Pain: A Global Perspective

IntroductionAlthough many efforts have been made to reduce racial pain disparities over decades, the pain of black patients is still undertreated. Previous work has identified a host of patient and...