“Discrimination negatively influences health and well-being in the general population, but its impact on people with pain is unclear,” explains Ruth A. Hackett, PhD. “Therefore, it is important to study the link between discrimination and health and well-being in those with pain. People with pain often report experiencing invalidation and stigma due to their pain, and pain is common among those who are socially marginalized, meaning they may be more likely to encounter discrimination in daily life. This goes beyond stigma specific to their pain experience and involves differential and unfair treatment based on characteristics such as age, race, sex, sexual orientation, or disability. There is also evidence that experiencing discrimination can lead to poor health. No previous study, however, has examined discrimination and later health outcomes in those with pain.”

For a paper published in Pain, Dr. Hackett and colleagues assessed discrimination, health, and well-being in people with and without pain. The researchers analyzed 6 years of data from 5,871 participants in a longitudinal epidemiological cohort of adults aged 50 and older. Experiences of discrimination were reported from 2010-2011. Pain, self-rated health, depressive symptoms, quality of life, life satisfaction, and loneliness were assessed from 2010-2011 and from 2016-2017. “We looked at adults who were initially pain-free,” Dr. Hackett says, “because we wanted to assess whether discrimination was more common in those with versus those without pain, and we sought to explore whether discrimination could increase the risk of developing pain in adults who were initially pain-free. We also looked at adults with current pain to see whether discrimination influenced their later health and wellbeing”

Discrimination Predictive of Pain in Pain-Free Adults

The study team found that people with pain were more likely to experience discrimination than those without pain. “This experience is associated with increased depression and loneliness,” Dr. Hackett notes. “We also found that discrimination was predictive of incident pain in pain-free adults.”

Cross-sectionally, those with pain who perceived discrimination had poor self-rated health (OR = 1.28, 95% CI, 1.02-1.61), greater depression symptoms (OR = 1.90, 95% CI 1.48-2.45), were more likely to be lonely (ß = 0.21, 95% CI 0.15-0.26), and had lower quality of life (ß = -4.01, 95% CI -4.88 to -3.14), and life satisfaction (ß = -1.75, 95% CI-2.45 to -1.06) than those with pain who did not receive discrimination  Prospectively, discrimination in those with pain was associated with greater depression (OR = 1.67, 96% CI 1.19-2.34) and loneliness (ß = 0.11, 95% CI 0.05-0.17), adjusting for baseline values. In those without pain from 2010 to 2011, discrimination predicted pain from 2016 to 2017, controlling for covariates (OR = 1.29, 95% CI 1.06-1.56; Table).

Social Marginalization Plays a Role

Study participants with pain were also more likely to be from socially marginalized groups. “There is evidence that people may engage in poor health behaviors as a method of coping with discrimination, or may find adhering to treatment regimens more difficult, which is relevant to patient care,” Dr. Hackett says. “Finally, there is emerging evidence that a perspective-taking intervention by physicians reduces racial and socioeconomic biases and, consequently, pain treatment disparities. A perspective-taking compassionate approach may be useful when considering the links between discrimination and health in this patient population.”

Dr. Hackett and colleagues concur that more research is needed to better understand the relationship between discrimination, pain, and poor health. “To our knowledge, this is the first study showing discrimination as a risk factor for developing pain,” she says. “In terms of our findings linking discrimination with poorer health and wellbeing in those with pain, we would like to see future research focus on the mechanisms underlying these relationships. Is it health behavior, used as a coping mechanism in response to discriminatory encounters, that links discrimination with poor health outcomes, or are there changes in stress-related biology that link the stress of discriminatory experiences with poor health and well-being? Focusing on mechanisms could offer insight into potentially modifiable factors that could break the link between discrimination and poor health and well-being outcomes.”