Applying the NIA Health Disparities Research Framework to Identify Needs and Opportunities in Chronic Musculoskeletal Pain Research

Patel, Monika; Johnson, Alisa; Booker, Staja Q.; Bartley, Emily J.; Palit, Shreela; Powell-Roach, Keesha; Terry, Ellen L.; Fullwood, Dottington; DeMonte, Lucas C.; Mickle, Angela; Sibille, Kimberly T.

doi:10.1016/j.jpain.2021.06.015

Cited by 14 publications

(26 citation statements)

References 160 publications

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“…One factor that prior reviews have highlighted as a contributor to racial disparities in pain outcomes involves group differences in pain assessment and treatment, which are widespread across settings. 22,30,36 For example, minority patients are consistently less likely to receive comprehensive diagnostic and treatment approaches for pain and more likely to have their pain underestimated by providers. 20,23,30 In previous studies of football players, injured Black professional ASF players (compared with their White peers) were deemed more likely to be able to play in a subsequent game with the assumption that they felt less pain than White players.…”

Section: Discussionmentioning

confidence: 99%

“…22,26,30 Race differences in health outcomes, including pain, are in part driven by social factors such as discrimination and bias, which have led to inequities in neighborhood environment, medical care, and socioeconomic position across the lifespan (ie, African Americans report more difficult socioeconomic circumstances relative to White Americans in the early life, midlife, and late life). 36 Professional American-style football (ASF) players represent a racially diverse group in which a majority of active professional players identify as Black or African American. American-style football players are exposed to high levels of physical trauma during their playing years, putting them at risk of persistent pain, lasting physical impairment, and substantial psychosocial distress.…”

Section: Introductionmentioning

confidence: 99%

“…33 However, the burden of pain is unequally distributed across racial and ethnic groups. 30,36 Recent reviews highlight the greater intensity of acute pain, the greater prevalence, severity, and impact of chronic pain, and the reduced access to and receipt of high-quality pain care among African Americans relative to White adults in the United States. 22,26,30 Race differences in health outcomes, including pain, are in part driven by social factors such as discrimination and bias, which have led to inequities in neighborhood environment, medical care, and socioeconomic position across the lifespan (ie, African Americans report more difficult socioeconomic circumstances relative to White Americans in the early life, midlife, and late life).…”

Section: Introductionmentioning

confidence: 99%

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Race differences in pain and pain-related risk factors among former professional American-style football players

Edwards¹,

Tan

Dairi³

et al. 2023

Pain

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The burden of pain is unequal across demographic groups, with broad and persisting race differences in pain-related outcomes in the United States. Members of racial and ethnic minorities frequently report more pervasive and severe pain compared with those in the majority, with at least some disparity attributable to differences in socioeconomic status. Whether race disparities in pain-related health outcomes exist among former professional football players is unknown. We examined the association of race with pain outcomes among 3995 former professional American-style football players who self-identified as either Black or White. Black players reported more intense pain and higher levels of pain interference relative to White players, even after controlling for age, football history, comorbidities, and psychosocial factors. Race moderated associations between several biopsychosocial factors and pain; higher body mass index was associated with more pain among White but not among Black players. Fatigue and psychosocial factors were more strongly related to pain among Black players relative to White players. Collectively, the substantial social and economic advantages of working as a professional athlete did not seem to erase race-related disparities in pain. We highlight an increased burden of pain among elite Black professional football players and identify race-specific patterns of association between pain and biopsychosocial pain risk factors. These findings illuminate potential future targets of interventions that may serve to reduce persistent disparities in the experience and impact of pain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Race differences in pain and pain-related risk factors among former professional American-style football players

Edwards¹,

Tan

Dairi³

et al. 2023

Pain

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“…(5) had prosthetic knee replacements or other clinically significant surgery to the affected knee; (6) had peripheral neuropathy; and/or (7) had systemic diseases including rheumatoid arthritis, systemic lupus erythematosus or fibromyalgia. Pooled data included the cross-sectional baseline time points only combining identical measures.…”

Section: Participantsmentioning

confidence: 99%

“…Second, studies with larger sample sizes of underrepresented groups are needed (7). Third, much of the existing research investigating differences in pain experiences between ethnic/race groups has focused on identifying and examining behavioral factors, with fewer studies evaluating environmental and sociocultural factors and the combination of factors across different levels of analysis (7). Fourth, two Health Disparities Research Frameworks have been developed (22,23).…”

Section: Additional Considerationsmentioning

confidence: 99%

Elucidating factors contributing to disparities in pain-related experiences among adults with or at risk for knee osteoarthritis

Mickle

Domenico²,

Tanner³

et al. 2023

Front. Pain Res.

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Background and purposeWe and others have reported ethnic/race group differences in clinical pain, physical function, and experimental pain sensitivity. However, recent research indicates that with consideration for socioenvironmental factors, ethnicity/race differences become less or non-significant. Understanding of factors contributing to pain inequities are needed. Guided by the NIA and NIMHD Health Disparities Research Frameworks, we evaluate the contributions of environmental and behavioral factors on previously reported ethnic/race group differences in: (1) clinical pain, (2) physical function, and (3) experimental pain in individuals with knee pain.MethodsBaseline data from Understanding of Pain and Limitations in Osteoarthritis Disease (UPLOAD) and UPLOAD-2 studies were analyzed. Participants were adults 45 to 85 years old who self-reported as non-Hispanic white (NHW) or black (NHB) with knee pain. A health assessment and quantitative sensory testing were completed. Sociodemographics, environmental, health, clinical and experimental pain, and physical functioning measures were included in nested regressions.ResultsPooled data from 468 individuals, 57 ± 8 years of age, 63% women, and 53% NHB adults. As NHB adults were younger and reported greater socioenvironmental risk than the NHW adults, the term sociodemographic groups is used. With inclusion of recognized environmental and behavioral variables, sociodemographic groups remained a significant predictor accounting for <5% of the variance in clinical pain and physical function and <10% of variance in experimental pain.ConclusionThe incorporation of environmental and behavioral factors reduced relationships between sociodemographic groups and pain-related outcomes. Pain sites, BMI, and income were significant predictors across multiple models. The current study adds to a body of research on the complex array of factors contributing to disparities in pain-related outcomes.

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Greater socioenvironmental risk factors and higher chronic pain stage are associated with thinner bilateral temporal lobes

Antoine,

Tanner,

Mickle

et al. 2023

Brain and Behavior

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Introduction: Previous research indicates ethnic/race group differences in pain and neurodegenerative diseases. Accounting for socioenvironmental factors reduces ethnic/race group differences in clinical and experimental pain. In the current study sample, we previously reported that in individuals with knee pain, ethnic/race group differences were observed in bilateral temporal lobe thickness, areas of the brain associated with risk for Alzheimer's disease, and related dementias. The purpose of the study was to determine if socioenvironmental factors reduce or account for previously observed ethnic/race group differences and explore if a combined effect of socioenvironmental risk and chronic pain severity on temporal lobe cortices is evident.Methods: Consistent with the prior study, the sample was comprised of 147 adults (95 women, 52 men), 45–85 years of age, who self‐identified as non‐Hispanic Black (n = 72) and non‐Hispanic White (n = 75), with knee pain with/at risk for osteoarthritis. Measures included demographics, health history, pain questionnaires, cognitive screening, body mass index, individual‐ and community‐level socioenvironmental factors (education, income, household size, marital and insurance status, and area deprivation index), and brain imaging. We computed a summative socioenvironmental risk index. Results: Regression analyses showed that with the inclusion of socioenvironmental factors, the model was significant (p < .001), and sociodemographic (ethnic/race) group differences were not significant (p = .118). Additionally, findings revealed an additive stress load pattern indicating thinner temporal lobe cortices with greater socioenvironmental risk and chronic pain severity (p = .048).Implications: Although individual socioenvironmental factors were not independent predictors, when collectively combined in models, ethnic/race group differences in bilateral temporal lobe structures were not replicated. Further, combined socioenvironmental risk factors and higher chronic pain severity were associated with thinner bilateral temporal lobes.

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Applying the NIA Health Disparities Research Framework to Identify Needs and Opportunities in Chronic Musculoskeletal Pain Research

Cited by 14 publications

References 160 publications

Race differences in pain and pain-related risk factors among former professional American-style football players

Race differences in pain and pain-related risk factors among former professional American-style football players

Elucidating factors contributing to disparities in pain-related experiences among adults with or at risk for knee osteoarthritis

Greater socioenvironmental risk factors and higher chronic pain stage are associated with thinner bilateral temporal lobes

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