Background & Aims
Many marginalized populations (e.g. racialized individuals) are more likely to experience discrimination, stress, and heightened vigilance (1). However, we do not know if this also extends to vulnerable pain populations. Recent work has identified a) positive associations between discrimination and pain (2) and b) high impact chronic pain and patients prescribed opioids experience social stigma (3,4). These outcomes indicate the importance of assessing potential differences in the incidence of discrimination, stress, and heightened vigilance as a function of chronic pain severity and opioid use. Here, we aimed to a) determine if individuals who use opioid pain medications and individuals with greater levels of pain interference experience greater levels of discrimination, stress, and vigilance b) assess whether we exhibit similar outcomes to the literature in these outcomes via demographics factors and c) assess whether depression, anxiety, and social isolation moderate these effects.
Methods
355 individuals who previously consented and opted into future research with the Pain Management Center at Stanford University School of Medicine completed a set of questionnaires related to social determinants of health. 240 individuals (67.6%) completed a three-month follow-up which included a subset of the initial questionnaires. Participants (75% women, 79.6% White, 28% taking opioid pain medications) answered PROMIS-related measures along with a battery of items related to social determinant of health (e.g., everyday discrimination). We also measured patient demographics (e.g., gender and race). We took advantage of our longitudinal data collection and used linear multilevel models in R to assess how pain interference, opioid use, and patient characteristics related to our outcomes: everyday discrimination (5), heightened vigilance (6), and perceived stress (7). We also ran maximal models that included social isolation, anxiety, and depression as potentially confounding factors.
Results
In our linear multilevel models, we initially observed positive associations between pain interference and discrimination (B =0.23, p < 0.001), stress (B =0.3, p < 0.001), and vigilance (B =0.13, p < 0.001); however, when we controlled for anxiety, depression, and social isolation, only the association between stress and pain interference held. We only observed a significant association between opioid use and stress (B =-1.4, p = 0.007); however, this did not hold in the maximal model. We observed an association by race and discrimination (B = -2.12, p < 0.001; White individuals reported the least discrimination) and stress (B = 0.72, p = 0.003; White individuals reported the most stress). We also noted associations between anxiety and stress (B =0.2, p < 0.001) and vigilance (B =0.08, p = 0.006) and associations between social isolation and vigilance (B =0.15, p < 0.001) and discrimination (B =0.21, p < 0.001). Finally, we did not observe associations between gender and our factors.
Conclusions
Contrary to our initial hypotheses, our results do not indicate more vulnerable pain populations (e.g., those who use opioid pain medication or those with greater pain interference) are more likely to report greater levels of discrimination or vigilance. We do note individuals with greater pain interference do report higher levels of stress, indicating stress as an important factor to consider with this population. We also note the critical role for including and controlling for factors related to emotional distress (e.g., anxiety and social isolation) when investigating social determinants of health. Indeed, our results suggest individuals with higher levels of anxiety had higher levels of self-reported stress and vigilance and individuals with higher levels of social isolation had higher levels of self-reported vigilance and discrimination.
References
1) Lewis, T. T., Yang, F. M., Jacobs, E. A., & Fitchett, G. (2012). Racial/ethnic differences in responses to the everyday discrimination scale: a differential item functioning analysis. American journal of epidemiology, 175(5), 391-401.
2) Edwards, R. R. (2008). The association of perceived discrimination with low back pain. Journal of Behavioral Medicine, 31(5), 379-389.
3) De Ruddere, L., & Craig, K. D. (2016). Understanding stigma and chronic pain: a-state-of-the-art review. Pain, 157(8), 1607-1610
4) Bulls, H. W., Chu, E., Goodin, B. R., Liebschutz, J. M., Wozniak, A., Schenker, Y., & Merlin, J. S. (2022). Framework for opioid stigma in cancer pain. Pain, 163(2), e182-e189
5) Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of health psychology, 2(3), 335-351
6) Clark, R., Benkert, R. A., & Flack, J. M. (2006). Large arterial elasticity varies as a function of gender and racism-related vigilance in black youth. Journal of Adolescent Health, 39(4), 562-569
7) Cohen, S., Kamarck, T., & Mermelstein, R. (1994). Perceived stress scale. Measuring stress: A guide for health and social scientists, 10(2), 1-2
Presenting Author
Troy C. Dildine
Poster Authors
Troy Dildine, Ph.D.
PhD
Department of Anesthesiology, Perioperative and Pain Medicine,Stanford University School of Medicine
Lead Author
Edward Lannon
PhD
Stanford University School of Medicine
Lead Author
Emma Raney
MPH
Stanford University School of Medicine
Lead Author
Sean Mackey
Stanford University
Lead Author
Dokyoung You
PhD
Stanford University School of Medicine
Lead Author
Topics
- Racial/Ethnic/Economic Differences/Disparities