Background & Aims
The most common form of chronic low back pain (cLBP) is non-specific[1], such that there is no known pathoanatomical cause of pain. As such, patients may experience stigmatizing reactions from family, friends, or healthcare providers, causing them to feel blamed and dismissed[2-5]. Additionally, compared to non-Hispanic Whites, the prevalence of chronic pain is higher among non-Hispanic Black individuals[6-10], who face additional injustices including race-based discrimination. Thus, it is important to understand how chronic pain stigma may intersect with the experience of racial discrimination within a minoritized group of Black individuals with cLBP. The present study examined the intersection between chronic pain stigma and racial discrimination, and how they synergistically related to psychological factors and pain. We then explored whether psychological factors contributed to the relationship between the intersection of chronic pain stigma and racial discrimination with pain.
Methods
Non-Hispanic Black participants with non-specific cLBP completed validated measures of chronic pain stigma, lifetime experience of racial discrimination, depression, pain catastrophizing, and clinical pain severity and interference. A composite variable of the intersectionality of chronic pain stigma and racial discrimination (ISD) was created using median splits. Participants who were ? the median for stigma and discrimination were labeled as “high ISD” and those < the median for stigma and discrimination were labeled as “low ISD.” Participants who were > the median on stigma but < the median on discrimination were labeled as “high stigma” and those who were < the median on stigma but > the median on discrimination were labeled as “high discrimination.” ANCOVAs were conducted to examine group differences in psychological factors and pain. Parallel mediation analyses were conducted to examine the extent to which psychological factors mediated the association between ISD and pain.
Results
Of all participants (N=153, Mage=45.73, 60% female), 29% were categorized as high ISD, 24% as low ISD, 25% as high stigma, and 22% as high discrimination. Participants in the high ISD and high stigma groups reported significantly greater depression, catastrophizing, pain severity, and pain interference than participants in the low ISD and high discrimination groups (ps<.01). There were no significant differences between the high ISD and high stigma groups, nor were there differences between the low ISD and high discrimination groups (ps>.05). As such, for the purpose of the mediation analyses, participants in the high ISD and high stigma groups were combined into one “high stigma” group, and participants in the low ISD and high discrimination groups were combined into one “low stigma” group. Mediation analyses showed that both depression and catastrophizing significantly mediated the association between high stigma and greater pain severity and interference.
Conclusions
The majority of research on racial disparities in pain has adopted a deficit framework focusing on between-group comparisons, often using White individuals as a reference group[11,12]. We used a within-group approach to gain deeper insight into how chronic pain stigma and racial discrimination synergistically relate to pain, specifically within a minoritized group of Black participants. We found that participants with high levels of stigma reported greater depression, catastrophizing, pain severity, and pain interference compared to participants with low levels of stigma, regardless of their experience with racial discrimination. Further, participants with high stigma reported greater depression and pain catastrophizing, which contributed to their higher levels of pain severity and interference. Future studies should examine the role of everyday experiences of racial discrimination, as the timeframe of these experiences may differentially intersect with stigma and impact pain outcomes.
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Presenting Author
Madelyn Crago
Poster Authors
Madelyn Crago
BSc
Brigham and Women's Hospital/Harvard Medical School
Lead Author
Jenna Wilson
PhD
Brigham and Women's Hospital; Harvard Medical School
Lead Author
Burel Goodin
Washington University in St. Louis
Lead Author
SAMANTHA MEINTS
PhD
Dept. of Anesthesiology, Perioperative & Pain Medicine, Brigham & Women’s Hospital, Boston, MA, USA
Lead Author
Topics
- Mechanisms: Psychosocial and Biopsychosocial