Background & Aims

Chronic musculoskeletal pain (CMP) is highly prevalent, frequently associated with negative health outcomes, and disproportionately impacts Black Americans (Mills et al., 2019; Nahin et al., 2023; Patel et al., 2022). Perceived racial and ethnic discrimination has emerged as a factor that may influence the experience of chronic pain in this population (Burgess et al., 2009). Identifying modifiable psychosocial factors that influence the link between perceived discrimination and pain and that can be directly targeted in treatment is vital to reducing the disproportionate burden of CMP among Black individuals. The present study examines the moderating role of five risk factors (i.e., pain avoidance, pain fusion, experiential avoidance, pain catastrophizing, and pain anxiety) on the relationship between perceived discrimination and pain outcomes (i.e., pain intensity and interference) in a sample of 401 Black adults with CMP.

Methods

We recruited 401 Black individuals (Mage = 35.98, 51.9% female) with self-reported CMP. Participants completed self-reported measures of perceived discrimination, pain intensity, pain interference, and pain-related psychosocial risk factors. The SPSS PROCESS macro (Hayes, 2012) was used to examine the moderating role of each psychosocial variable on the relation between perceived discrimination and pain outcomes and to probe conditional effects of the focal predictor for each significant interaction (i.e., simple slope analysis).

Results

Higher scores on each psychosocial risk factor (i.e., pain avoidance, pain fusion, experiential avoidance, pain catastrophizing, and pain anxiety) were associated with greater pain intensity and pain interference (ps<.01). Further, pain avoidance (p=.006), pain fusion (p=.002), and pain anxiety (p=.002) each significantly moderated the relation between perceived discrimination and pain intensity. Greater perceived discrimination was associated with greater pain intensity at higher levels of avoidance and fusion, and was associated with less pain intensity at lower levels of avoidance and pain anxiety. In models predicting pain interference, both pain fusion (p=.001) and pain anxiety (p=.01) significantly moderated the relation between perceived discrimination and pain interference. Perceived discrimination was associated with greater pain interference at higher levels of fusion and pain anxiety, and was not associated with pain interference at lower levels of fusion and pain anxiety.

Conclusions

Overall, the present study advances our understanding of psychosocial risk factors that exacerbate the link between perceived discrimination and pain outcomes, providing important clinical implications for the treatment of Black adults with chronic musculoskeletal pain. Specifically, with respect to the perceived discrimination-pain linkage, both pain anxiety and psychological inflexibility may be of significant clinical importance; the reduction of pain anxiety may be an important intervention target among individuals with higher perceived discrimination, while pain-related psychological flexibility offers a potential avenue for reducing the burden of perceived discrimination on pain outcomes.

References

Burgess, D. J., Grill, J., Noorbaloochi, S., Griffin, J. M., Ricards, J., Van Ryn, M., & Partin, M. R. (2009). The effect of perceived racial discrimination on bodily pain among older African American men. Pain Medicine, 10(8), 1341–1352.
Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, mod- eration, and conditional process modeling [White paper]. Retrieved from https://www.afhayes.com/ public/process2012.pdf
Mills, S. E. E., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: A review of its epidemiology and associated factors in population-based studies. British Journal of Anaesthesia, 123(2), e273–e283.
Nahin, R. L., Feinberg, T., Kapos, F. P., & Terman, G. W. (2023). Estimated rates of incident and persistent chronic pain among US adults, 2019-2020. JAMA Network Open, 6(5), e2313563.
Pascoe, E. A., & Richman, L. S. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135(4), 531–554.
Patel, M., Johnson, A. J., Booker, S. Q., Bartley, E. J., Palit, S., Powell-Roach, K., Terry, E. L., Fullwood, D., DeMonte, L., Mickle, A. M., & Sibille, K. T. (2022). Applying the NIA Health Disparities Research Framework to identify needs and opportunities in chronic musculoskeletal pain research. The Journal of Pain, 23(1), 25–44.

Presenting Author

Katherine E. Gnall

Poster Authors

Katherine Gnall

MSc

University of Connecticut

Lead Author

Julia Hooker

Massachusetts General Hospital/Harvard Medical School

Lead Author

James Doorley

PhD

United States Olympic & Paralympic Committee, Department of Sports Medicine

Lead Author

Jafar Bakhshaie

PhD

Lead Author

Ana-Maria Vranceanu

Massachusetts General Hospital/Harvard Medical School

Lead Author

Topics

  • Racial/Ethnic/Economic Differences/Disparities