Examining Associations Among Daily Discrimination, Psychosocial Risk Factors, and Pain Outcomes in People with Chronic Low Back Pain

Joanna Hobson^1,2Matthew C Morris³Robert Ernest Sorge⁴D Leann Long⁵Tammie Quinn⁴Demario S Overstreet⁴Asia M Wiggins⁴Eeshaan K Bajaj⁴Jonas G Dembowski⁴Edwin Aroke⁴Burel R Goodin⁶Calia A Morais^4*

• ¹University of Florida, Gainesville, United States
• ²Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, United States
• ³University of Mississippi Medical Center, Jackson, Mississippi, United States
• ⁴University of Alabama at Birmingham, Birmingham, Alabama, United States
• ⁵Wake Forest University, Winston-Salem, North Carolina, United States
• ⁶Washington University in St. Louis, St. Louis, Missouri, United States

Abstract Substantial evidence suggests that experiences of discrimination negatively influence sleep, depressive symptoms, stress, and pain. The purpose of this study was to evaluate the strength of the associations between discrimination and pain, and to determine which psychosocial risk factors help explain these associations. Participants (N=208) underwent two study sessions, where they completed the Everyday Discrimination Scale, Perceived Stress Scale, Centers for Epidemiological Studies Depression Scale, Insomnia Severity Index, and the Brief Pain Inventory – Short Form. Demographic data was also obtained from participants. Majority of the participants self-identified as women (55.3%), and Black (62%). There were positive associations between discrimination and insomnia (p < .001), depressive symptoms (p < .001), perceived stress (p < .001), pain severity (p < .001) and pain interference (p < .001). Hierarchical regressions showed that identifying as Black (p < .001), having greater depressive symptoms (p = .03), and greater insomnia symptoms (p < .001) were associated with greater pain severity in the past 24 hours. Similarly, older age (p = .01), identifying as Black (p = .002), having lower education (p = .04), taking medications (p = .04), greater depressive (p < .001) and insomnia symptoms (p < .001) were associated with greater pain interference. The indirect effect of discrimination on pain severity was significant (β = .015, Bootstrap 95% CI .003 - .030). Additionally, there was a significant indirect effect of discrimination on pain interference (β = .015, Bootstrap 95% CI .004 - .031). Exploratory models showed an indirect effect of pain severity (β = .014, Bootstrap 95% CI .001 - .029) and interference (β = .012, Bootstrap 95% CI .000 to .029) on discrimination via psychosocial risk factors. Our findings highlight the harmful associations between discrimination, mental health outcomes, pain severity, and reduced quality of life. Additionally, these findings emphasize the need for more stress engaged research to continue exploring these potential relationships, identify cause-effect and inform the development of future interventions focused on reducing the negative impact of stress on pain outcomes - especially for minority groups who are disproportionately affected by pain disparities.