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

Abstract

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.

Environmental and sociocultural factors are associated with pain-related brain structure among diverse individuals with chronic musculoskeletal pain: intersectional considerations

“…Imbalances in the representation by different ethnic-race groups from different environmental and sociocultural backgrounds have likely contributed to observed disparities 25 . We and others have shown that with consideration for socioenvironmental factors such as education, income, neighborhood housing status, and experiences of discrimination, previously reported ethnic-race group disparities wane in clinical and experimental pain 26 .…”

Osteoarthritis and social disadvantage interactions: retrospective overview and emergent findings and health implications

“…In sum, to alleviate the current and future osteoarthritis burden, the interaction of the aging adult's needs, situational, and environmental factors including income and insurance [58][59][60] that can potentiate excess distress and pain, plus health disparities, enormous physical, social, occupational, and mental distresses, must be considered in parallel and intervened upon thoughtfully, comprehensively, in a timely as well as empathetic manner as indicated. However, while this idea is not novel and is consistent with social cognitive theory precepts that are well accepted as explanatory, behavioral and health intervention outcome attributes, unfortunately, this approach is not a mainstream one in any respect.…”

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

“…Results align with the hypothesized interpretation consistent with the allostatic load model, and physiological and neurobiological systems are adaptive to stress until the cumulative load exceeds functional capacity (McEwen, 1998 , 2015 ). Hence, individuals with “combined loads” of high socioenvironmental risk and high chronic pain stage show greater neurobiological “load” as indicated by a pattern of thinner temporal lobe brain structures than their peers with lower levels of socioenvironmental risk and lower levels of chronic pain stage (Mickle et al., 2023 ).…”

“…Determining the influence of socioenvironmental factors on health outcomes is essential to reducing health disparities and improving health for all. Socioenvironmental factors are associated with chronic pain and brain structure/function (Elbejjani et al., 2017 ; Mickle et al., 2023 ; Peters, 2006 ). Importantly, although socioenvironmental factors were not independently predictive in the adjusted analyses, with the inclusion of an array of socioenvironmental factors, previously observed sociodemographic (ethnic/race) groups, that is, NHB and NHW adults, bilateral temporal lobe cortical thickness differences were no longer observed (Tanner et al., 2021 ).…”

“…Ethnic/race group disparities have been reported across experimental and clinical pain (Kim et al., 2017 ; Vaughn et al., 2019 , 2018 ). However, building research shows that when socioenvironmental factors are accounted for, ethnic/race group differences wane (Mickle et al., 2023 ; Mullins et al., 2022 ; Zajacova et al., 2022 ). In fact, our recent findings, based on data from two different studies, including participants for the current study sample, show that with the inclusion of socioenvironmental factors in analyses, previously reported ethnic/race group differences in experimental and clinical pain are reduced (Mickle et al., 2023 ).…”