Experience Of Chronic Pain Research Articles

Monoamine control of descending pain modulation after mild traumatic brain injury

Traumatic brain injury (TBI) is a significant public health concern, with the majority of injuries being mild. Many TBI victims experience chronic pain. Unfortunately, the mechanisms underlying pain after TBI are poorly understood. Here we examined the contribution of spinal monoamine signaling to dysfunctional descending pain modulation after TBI. For these studies we used a well-characterized concussive model of mild TBI. Measurements included mechanical allodynia, the efficacy of diffuse noxious inhibitory control (DNIC) endogenous pain control pathways and lumber norepinephrine and serotonin levels. We observed that DNIC is strongly reduced in both male and female mice after mild TBI for at least 12 weeks. In naïve mice, DNIC was mediated through α2 adrenoceptors, but sensitivity to α2 adrenoceptor agonists was reduced after TBI, and reboxetine failed to restore DNIC in these mice. The intrathecal injection of ondansetron showed that loss of DNIC was not due to excess serotonergic signaling through 5-HT3 receptors. On the other hand, the serotonin-norepinephrine reuptake inhibitor, duloxetine and the serotonin selective reuptake inhibitor escitalopram both effectively restored DNIC after TBI in both male and female mice. Therefore, enhancing serotonergic signaling as opposed to noradrenergic signaling alone may be an effective pain treatment strategy after TBI.

OA02 Paediatric chronic pain and Autism Spectrum Disorder: is there a link?

Introduction/BackgroundTo review the literature on chronic pain and autism spectrum disorder (ASD). A key aim is to explore the prevalence of chronic pain in children with ASD and the impact that ASD could have on the experience of chronic pain.Description/MethodAfter reviewing the literature, a thematic analysis was completed in order to identify key patterns. The thematic analysis identified four key topics: Prevalence of chronic pain in ASD; Impact of comorbid ASD and chronic pain; Psychological flexibility; Sensory sensitivities.Discussion/ResultsThe literature demonstrates that the prevalence of chronic pain is higher in children with ASD than the general population; studies show the prevalence of pain to be almost doubled in children with ASD (ASD = 15.6%; without ASD = 8.2%). Chronic pain can also have a more significant impact on functioning in children who exhibit ASD traits, shown through higher pain interference, higher depression levels and lower health related quality of life. This greater functional impairment means interventions are particularly important, however, challenges are highlighted by the literature; ASD traits may affect the efficacy of talking therapies and treatment guidelines are not specific, such as those for comorbid ASD and anxiety not being intended for use with physical health conditions.An important protective factor identified in comorbid chronic pain and ASD is psychological flexibility; acting on long-term values rather than current thoughts and feelings. However, this is typically low in ASD thus highlighting a role for Acceptance and Commitment Therapy (ACT), which aims to increase psychological flexibility. This is supported in chronic pain research where ACT leads to improved functioning, particularly in those with higher ASD traits.A discrepancy exists in chronic pain literature as there is a higher prevalence of children with clinically significant ASD traits than with confirmed ASD diagnosis. It appears that medically unexplained pain can interfere with ASD diagnosis, with it often being the first presenting symptom in undiagnosed ASD, and oversensitivity to pain has been associated with delayed ASD diagnosis. Sensory and perceptual abnormalities are commonly seen in ASD, with research indicating an underlying link between hypersensitivity and pain. However, current pain sensitivity findings can often not be generalised to children with comorbid chronic pain and ASD; studies tend to exclude those with such physical health conditions and investigate only acute pain sensitivity in ASD.Key learning points/ConclusionThere is a link between chronic pain and ASD evident in the literature as children with ASD are at a higher risk of developing chronic pain than the general population, particularly if they also experience abnormal or hypersensitivities.Chronic pain is likely to have a greater impact on children with ASD, including higher depression levels and lower quality of life.Due to the risk for greater functional impairment, it is particularly important to manage chronic pain in children with ASD, however common ASD traits and a lack of specific guidelines pose challenges in doing so.Due to a lack of existing research, further research is required to gain understanding of the link between chronic pain and ASD, including exploring sensory abnormalities in chronic pain and the management of comorbid chronic pain and ASD.It is important raise awareness of this association amongst clinicians, particularly due to the prevalence of undiagnosed ASD, the impact on intervention, and the risk for more severe functional impairment in paediatric chronic pain.

The experience of chronic pain among adolescents: suffering and attempt to overcome pain?

BackgroundChronic pain (CP) among adolescents has received less attention than adultsandthere is limited qualitative studies about it in Iran. This study explored the experience of CP among adolescents.MethodsThis exploratory qualitative study was conducted in April–October 2019. Participants were 14 adolescent students purposively recruited from schools in Shiraz, Iran. Semi-structured interviews were conducted for data collection and data analysis was done through conventional content analysis.FindingsAdolescents’ experiences of CP came into nine subcategories and three main categories, namely perceived suffering, attempt to overcome pain, and attempt to find sources of support.ConclusionAdolescents with CP experience physical and mental suffering and attempt to manage their pain and its associated suffering through different physical and psychological strategies and using different sources of support such as family, peers, healthcare providers, and school staff.

A Bayesian model for chronic pain.

The perceiving mind constructs our coherent and embodied experience of the world from noisy, ambiguous and multi-modal sensory information. In this paper, we adopt the perspective that the experience of pain may similarly be the result of a probabilistic, inferential process. Prior beliefs about pain, learned from past experiences, are combined with incoming sensory information in a Bayesian manner to give rise to pain perception. Chronic pain emerges when prior beliefs and likelihoods are biased towards inferring pain from a wide range of sensory data that would otherwise be perceived as harmless. We present a computational model of interoceptive inference and pain experience. It is based on a Bayesian graphical network which comprises a hidden layer, representing the inferred pain state; and an observable layer, representing current sensory information. Within the hidden layer, pain states are inferred from a combination of priors , transition probabilities between hidden states and likelihoods of certain observations . Using variational inference and free-energy minimization, the model is able to learn from observations over time. By systematically manipulating parameter settings, we demonstrate that the model is capable of reproducing key features of both healthy- and chronic pain experience. Drawing on mathematical concepts, we finally simulate treatment resistant chronic pain and discuss mathematically informed treatment options.

Queer and Present Danger: Freakery and Sapphic Desire in Maria Edgeworth’s Belinda

This essay examines the relationship between (dis)ability and sexuality in Maria Edgeworth’s Belinda (1801). Jason Farr argues that (dis)ability and sexuality are “mutually constitutive” in the eighteenth century and demonstrates the link between conceptions of (dis)ablebodiedness and non-heteronormativity. I argue that the constitutive relationship is bifurcated across two characters from Edgeworth’s novel: Harriet Freke’s sexual divergence constitutes her disability, and Lady Delacour’s experience of disability and chronic pain constitutes her sexual ambiguity and Sapphic possibilities. A queer-crip reading of Belinda demonstrates that Lady Delacour experiences intimate relationships with women and her husband through her injured breast and chronic pain. Harriet Freke’s divergent gender performance disables her under the chastising gaze of the other characters, and, in the end, she is permanently, physically marked by an injury. Lady Delacour experiences a cure of her long-term injury that results in a transformation to the ennobled, contemporary form of heterosexual domesticity.

Reading Wharton with Pain: On Rest, Practices, and Care.

Critics have widely regarded Edith Wharton's Twilight Sleep (1927) as an ironic novel about pain: a satire of modern life's supposed promise that pain can be avoided. This essay argues that Wharton's novel is as much about managing pain as it is about avoiding it. I consider the novel in light of experiences of chronic pain and illness, both Wharton's and my own. My analysis finds that while the novel's satire targets the fleeing of pain, the text also engages aspects of life lived with pain. The characters demonstrate constant fatigue, a symptom of pain's presence; they undertake mental, physical, and care practices as modes of pain management; and the text's formal structures suggest chronic pain's duration. By focusing not on direct representations of pain but on how pain can condition a life (and a narrative), I elucidate the ongoing value of making a distinction between managing pain and avoiding it.

Agile development of a digital exposure treatment for youth with chronic musculoskeletal pain: protocol of a user-centred design approach and examination of feasibility and preliminary efficacy

IntroductionChronic pain affects a significant number of children and impacts multiple domains including social, emotional and behavioural functioning, and negatively impacts family functioning. Roughly 5% of youth with chronic pain...

Differentiating Gender and Sex in Dental Research: A Narrative Review.

While in humans the term “sex” refers to the biological attributes that distinguish subjects as male, female, and intersex, the term “gender” refers to psychological, social, and cultural factors that strongly influence attitudes, behaviors, and relationships of individuals. Recently, it has been emphasized how the integration of these two terms in the design of the research can improve the methodology of the research itself. However, in dental research, the influence of gender has not gained enough consideration and it is often used indiscriminately as a synonym for sex. This narrative review discusses the usefulness of considering gender and sex in dental research, whose guidelines have been provided so far on this topic, and whether the top 20 dental scientific journals promote the analysis of sex and gender in their guidelines. Sex and gender analysis in dental research could be important both for analyzing biological differences such as those in the immune or neuro-immune system, cardiovascular physiology, developmental anomalies or deformities, and psychosocial differences such as lifestyle, pain experience and prevalence of chronic pain, eating behavior, and access to healthcare services. As for the specific policies for sex and gender analysis and reporting, only five out of 20 biomedical journals have included them in their editorial policy, which refers mainly to the correct use of the terms “sex” and “gender.” In conclusion, we found that no specific and differentiated sex and gender analysis and reporting are required in dental journals. Their integration, which is still not routinely applied, may be improved in the future by updating editorial guidelines and developing more specific methodological recommendations.

Resilience as a protective factor in face of pain symptomatology, disability and psychological outcomes in adult chronic pain populations: a scoping review.

Patients suffering from chronic pain experience significant disability and disease burden. Resilience has been understood to be a protective factor in face of adversity, eventually contributing to positive outcomes. As such, the current review sought to summarize the existing literature focusing on the roles of resilience in relation to pain phenomenology, pain outcomes (including function and mental health), amongst relevant clinical correlates in a bid to promote holistic management of debilitating chronic pain conditions from a resilience-oriented psychotherapeutic approach as an adjunct to pharmacological treatment. A scoping review was conducted on empirical studies surrounding the theme of resilience in adult chronic pain populations published before 9th May 2021. The following main inclusion criteria was applied; (a)adults diagnosed with chronic pain disorders, (b)use ofquantifiable pain measures, (c)use of quantifiable resilience measures. A total of 32 studies were then selected for the review. First, higher levels of resilience were associated with a reduced likelihood of experiencing any chronic pain, fewer pain sites, better psychological response towards nociception and reduced need for analgesia. Second, higher levels of resilience correlated with better daily and physical function, quality of life, psychosocial functioning and lower likelihood of co-morbid mental health disorders. Third, resilience was an intermediary variable in the pathways from pain phenomenology leading to pain interference, depression and post-traumatic growth. The findings were contextualized using pain-disability and resilience frameworks (The Pain and Disability Drivers Model, O'Leary's Resilience models) with suggestions to enhance resilience and contextual factors in the holistic management of adult chronic pain conditions. Future research should examine the differences in resilience between pain types as well as evaluate the efficacy of streamlined resilience-oriented interventions.

Sexual Functioning Among Adults with Chronic Pain: Prevalence and Association with Pain-Related Outcomes.

Prior research indicates that sexual functioning and chronic pain commonly coexist and impact each other; however, there are limitations in current research as to the prevalence and severity of sexual dysfunction in patients with chronic pain. This study used detailed measures across multiple domains of sexual functioning to describe the prevalence and correlates of self-reported sexual functioning among individuals with chronic pain presenting for treatment at a multidisciplinary pain management center (N = 247). Domains included sexual interest, satisfaction with sexual functioning, vaginal lubrication, vaginal discomfort, and erectile function. Individuals with and without sexual dysfunction were compared on pain-related outcome variables. Results from this study showed a high prevalence of sexual dysfunction in populations with chronic pain and a positive association between sexual problems and pain severity and psychological concerns. Sex differences were noted, with female participants exhibiting significantly lower sexual satisfaction associated with higher levels of pain, pain-related life interference, depression, and anxiety, whereas these relationships were not significant for male participants. Findings demonstrated that patients with chronic pain experience significant sexual dysfunction, including lack of interest in sexual activity and low satisfaction with their sex lives. Compared with patients without sexual dysfunction, patients with sexual dysfunction reported higher average pain levels and higher depressive symptoms, along with greater anxiety in patients with at least one area of sexual dysfunction. Adding to these findings are the pain-relevant correlates of sexual functioning domains and sex differences in these relationships, with women experiencing additional pain-related problems. Limitations and future research directions are discussed.

NAbiximols Clinical Translation To the treatment of Pain and Agitation In Severe Dementia (NACTOPAISD): Clinical trial protocol

Up to 80 % nursing home residents with dementia experiences chronic pain. Contextually, 97 % presents fluctuant neuropsychiatric symptoms (NPS). Among the most challenging is agitation, connected with undertreated pain and managed through neuroleptics doubling death risk. Evidence is accumulating in favor of the involvement of the endocannabinoid system in nociception and NPS. This double-blind, placebo-controlled, randomized trial (NAbiximols Clinical Translation To the treatment of Pain and Agitation In Severe Dementia [NACTOPAISD]) aims at investigating efficacy and safety of oral spray nabiximols, containing Δ9-tetrahydrocannabinol and cannabidiol (Sativex®), for pain and agitation treatment in severe dementia patients (Mini-Mental State Examination ≤ 12) over 65. The coprimary endpoints are efficacy on pain and agitation, assessed through the recently validated Italian Mobilization–Observation–Behavior–Intensity–Dementia and the Cohen-Mansfield Agitation Inventory. The secondary endpoint is the evaluation of efficacy duration after wash-out and the assessment of quality of life through the DEMQOL. Any adverse events will be reported. The results undergo statistical analysis plan. NACTOPAISD might provide rationale for a translational safer pain and agitation treatment in severe dementia. It is approved by Calabria Region Ethics Committee and follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and the Consolidated Standards of Reporting Trials (CONSORT) statements.

Tune out pain: Agency and active engagement predict decreases in pain intensity after music listening.

Music is increasingly being recognised as an adjuvant treatment for pain management. Music can help to decrease the experience of both chronic and experimental pain. Cognitive agency has been identified as a specific mechanism that may mediate the analgesic benefits of music engagement however, it is unclear if this specific mechanism translates to acute pain. Previous attempts to understand the cognitive mechanisms that underpin music analgesia have been predominantly lab-based, limiting the extent to which observed effects may apply to participants' everyday lives. Addressing these gaps, in naturalistic settings, the present study examined the degree to which cognitive agency (i.e., perceived choice in music), music features (i.e., complexity), and individual levels of musical sophistication were related to perceived pain. In an online global experiment, using a randomised between groups experimental design with two levels for choice (no choice and perceived choice) and two levels for music (high and low complexity), a sample of 286 adults experiencing acute pain reported their pain intensity and pain unpleasantness pre- and post-music listening. A bespoke piece of music was co-created with a commercial artist to enable the manipulation of music complexity while controlling for familiarity, while facilitating an authentic music listening experience. Overall, findings demonstrated that increased perceived control over music is associated with analgesic benefits, and that perceived choice is more important than music complexity. Highlighting the importance of listener engagement, people who reported higher levels of active engagement experienced greater decreases of pain intensity in the perceived choice condition, than those who reported lower levels of active engagement. These findings have implications for both research and practice, emphasising the importance of facilitating freedom of choice, and sustained engagement with music throughout music listening interventions.

Development of a novel intervention to improve sleep and pain in patients undergoing total knee replacement

BackgroundUp to 20% of patients experience long-term pain and dissatisfaction after total knee replacement, with a negative impact on their quality of life. New approaches are needed to reduce the proportion of people to go on to experience chronic post-surgical pain. Sleep and pain are bidirectionally linked with poor sleep linked to greater pain. Interventions to improve sleep among people undergoing knee replacement offer a promising avenue. Health beliefs and barriers to engagement were explored using behaviour change theory. This study followed stages 1–4 of the Medical Research Council’s guidance for complex intervention development to develop a novel intervention aimed at improving sleep in pre-operative knee replacement patients.MethodsPre-operative focus groups and post-operative telephone interviews were conducted with knee replacement patients. Before surgery, focus groups explored sleep experiences and views about existing sleep interventions (cognitive behavioural therapy for insomnia, exercise, relaxation, mindfulness, sleep hygiene) and barriers to engagement. After surgery, telephone interviews explored any changes in sleep and views about intervention appropriateness. Data were audio-recorded, transcribed, anonymised, and analysed using framework analysis.ResultsOverall, 23 patients took part, 17 patients attended pre-operative focus groups, seven took part in a post-operative telephone interview, and one took part in a focus group and interview. Key sleep issues identified were problems getting to sleep, frequent waking during the night, and problems getting back to sleep after night waking. The main reason for these issues was knee pain and discomfort and a busy mind. Participants felt that the sleep interventions were generally acceptable with no general preference for one intervention over the others. Views of delivery mode varied in relation to digital move and group or one-to-one approaches.ConclusionExisting sleep interventions were found to be acceptable to knee replacement patients. Key barriers to engagement related to participants’ health beliefs. Addressing beliefs about the relationship between sleep and pain and enhancing understanding of the bidirectional/cyclical relationship could benefit engagement and motivation. Individuals may also require support to break the fear and avoidance cycle of pain and coping. A future intervention should ensure that patients’ preferences for sleep interventions and delivery mode can be accommodated in a real-world context.

Discordance in Addressing Opioid Crisis in Rural Communities: Patient and Provider Perspectives.

Providing patient-centered care to manage chronic pain and opioid use disorder (OUD) is associated with improved health outcomes. However, adopting a holistic approach to providing care is often challenging in rural communities. This study aims to identify and contrast challenges to providing patient-centered care from the perspective of patients and providers. A participatory design approach was adopted to elicit the perceptions of providers and patients with lived experiences of chronic pain and/or OUD in Jefferson County, Wisconsin. Two focus groups were conducted with each stakeholder group to identify problems that participants face with respect to chronic pain management and OUD and possible solutions. Four interviews were conducted with providers experienced in chronic pain management. Analysis of focus group sessions and interviews show consensus among patients and providers that lack of behavioral health and recovery resources create barriers to effectively manage OUD and chronic pain. However, there was discordance among the two groups about other barriers such as patient and provider attitudes, tapering approach, and access to medications for OUD. This tension among patients and providers can influence patients’ retention in therapy. More efforts are needed to mitigate stigma among providers in rural communities and support psychosocial needs of patients.

Squeaky/Pain: Articulating the Felt Experience of Pain for Somaesthetic Interactions

This pictorial illustrates the methodological tools for articulating the felt experience of chronic pain used for designing somaesthetic interactions. To do this, it presents the design process of a case study named Squeaky/Pain, a soma extension aiming to augment somaesthetic awareness of the pain involved in the appreciation of both pleasant and disturbing feelings and sensations. The soma extension is an interactive wearable that facilitates a sound-motion interaction to mimic the wearer’s pain experience, from agony to relief. The case study focuses on a less explored aspect of somaesthetic interactions which is the mediation of disturbing experiences for sensory awareness. Through the soma extension that mediates disturbing experiences, the study aims to improve people’s somatic knowledge and their lives as a result. The design process of Squeaky/Pain requires detailed accounts of lived bodily experiences to create somaesthetic interactions. To access a detailed articulation of felt experiences, various tools are employed to articulate the first- and second-person pain experience for design use. These are different types of body maps, video analysis, material and form explorations, journals, in-depth interviews and self-interviews. The ideation and the testing phases have proven that such tools complement one another to access the versatile aspects of felt experiences. In this pictorial, we demonstrate ways in which visual, verbal and written tools can be applied to reveal implicit bodily experiences to inform somaesthetic interaction design.

Indications and Outcomes of a Hybrid Method Combining Laparoscopic and Anterior Approaches for Inguinal Hernia Repair.

IntroductionSurgery for complex inguinal hernia (IH) (recurrent IH or IH after radical prostatectomy (RP)) may be difficult because of the presumed scar or adhesion in the retropubic space. A hybrid method combining the laparoscopic and anterior approaches (HLAA) in a bidirectional surgical technique may be an option in complex IH cases.MethodsPatients at our institution who underwent IH repair for complex IH using HLAA from April 2018 to November 2019 were included. We retrospectively evaluated the patient characteristics, IH diagnosis, intraoperative variables, complications, and hernia recurrence during the follow-up period.ResultsTwenty patients were involved in this study. Seven patients underwent hLAA for recurrent IH, whereas the remaining 13 underwent hLAA for IH after RP. Five patients had bilateral IH, all of whom had IH after RP. The type of IH was lateral in 21 patients, medial in six patients, and lateral and medial in two patients. Hernia repair was performed using a patch alone in two patients and a plug and patch in 18 patients. Seroma or hematoma was observed in five patients, and one patient experienced chronic pain. No hernia recurrence was observed during the median follow-up period of 24 months.ConclusionhLAA could facilitate precise diagnosis and intraoperative confirmation of repair for recurrent IH and IH after RP. The intraoperative findings and the cause of recurrence can be easily shared among surgeons in hLAA. Further investigations are necessary to determine the long-term efficacy of hLAA in a larger cohort.

Chronicling the chronic: narrating the meaninglessness of chronic pain

This article proposes a way of narrating chronic pain: the telling of a chronicle. Recent work in the medical humanities has been critical of traditional approaches to illness narratives. In...

The Pain-Invalidation Scale: Measuring Patient Perceptions of Invalidation Toward Chronic Pain

Increasing evidence reveals the damaging impact of having one's chronic pain symptoms invalidated through disbelief, discrediting, and critical judgement. In other instances, a caregiver's over-attentiveness to the daily tasks of individuals with pain can be problematic, potentially undermining rehabilitation. The aim of this study was to develop an instrument to measure different aspects of invalidation perceived by people with chronic pain. Item generation was informed through literature review and a thematic analysis of narratives from 431 peer-reviewed articles. The crowdsourcing platform Prolific was used to distribute survey items to participants. In Study 1A, Principal Component Analysis was performed on data from 302 respondents, giving rise to 4 subscales, including: Invalidation by the Self, Invalidation by Immediate Others, Invalidation by Healthcare Professionals, and Invalidation by Over-attentive Others. Confirmatory Factor Analysis of data collected from another 308 individuals in Study 1B supported the 4-factor model of the Pain-Invalidation Scale (Pain-IS) and identified a best-fit model with 24 items. The Pain-IS was further validated in another 300 individuals in Study 2. The Pain-IS demonstrates sound psychometric properties and may serve as a valuable tool for use by clinicians in the detection of pain-invalidation issues, as a first step in patient pain management. PerspectiveLinks between pain-invalidation and pain levels, as well as functional detriment, highlight the importance of having one's chronic pain experience heard, believed, and accepted. The Pain-Invalidation Scale is designed to identify domains where invalidation of the patient's pain should be addressed to promote emotional processing, treatment adherence, and improved outcomes.

Negative impact of chronic pain: The role of locus of control and perceived family validation of chronic pain.

The present study investigates how participants’ locus of control and their family and friends’ validation of their pain influences participants’ chronic pain experiences. Four thousand, 25 adults were recruited through the Chronic Pain In America survey. Results show that individuals who endorse an internal locus of control and experience family and friends’ validation of their chronic pain reported better chronic pain outcomes and less negative life impact due to chronic pain. The current results indicate the locus of control and family and friends’ validation of chronic pain experience plays an important role in chronic pain and the impact of chronic pain across the life course.

Comparison of pain and psychosocial correlates among Hispanic and Non-Hispanic White youth with chronic pain.

Introduction:Despite well-documented pain disparities among adults from non-White and Hispanic groups, less is known about pain disparities in non-White and Hispanic pediatric populations.Objectives:We compare pain and related psychosocial factors at the individual (pain intensity, pain interference, pain catastrophizing, co-occurring symptoms), social (peer relations), and systemic (health insurance) levels among Hispanic and Non-Hispanic White (NHW) youth with chronic pain.Methods:Eight hundred thirty-seven (71.4% female) Hispanic (n = 268, 32%) and NHW (n = 569, 68%) youth ages 8 to 17 years (M = 14.00; SD = 2.54) completed a survey at their initial visit to a pain clinic. Independent sample t tests investigated mean differences in psychosocial factors at the individual and social levels. Chi-squared tests investigated differences at the systemic level. Bivariate correlations for each group were compared using Fisher r-to-z transformations.Results:.Hispanic youth reported higher levels of pain intensity (t[811] = −2.75, P = 0.006). Groups did not differ in reports of other individual or social factors. Non-Hispanic White youth were more likely to have private insurance (OR, 5.66). All examined variables were significantly correlated among NHW youth. Correlations were weaker or nonsignificant among Hispanic youth. Fisher r-to-z transformations revealed these group differences to be significant.Conclusion:Hispanic youth report higher pain levels than NHW counterparts and lower likelihood of having private insurance. Pain and psychosocial factors correlate differently among the 2 groups highlighting a need to better understand the chronic pain experiences of diverse youth because models derived primarily from NHW populations may not generalize across ethnic and racial groups.