Discrimination and wellbeing are differentially related to pain severity for the racially marginalized

Abstract

Objective: This study examines the relationship between racial discrimination and physical pain outcomes.

Methods: A geographically representative sample of 887 individuals was recruited online through CloudResearch from diverse racial backgrounds, including Black/African American, Latine/Hispanic American, Asian American, and White/European American adults. Participants completed measures on racial and ethnic discrimination, racial microaggressions, pain severity, depression symptoms, and coping styles. Statistical analyses included multiple regression and mediation models.

Results: Our findings indicate that racialized participants experienced greater ethnic discrimination and racial microaggressions compared to their non-Hispanic White counterparts. Hispanic/Latine participants also reported greater pain severity than other groups. Lifetime experiences of discrimination, depression symptoms, avoidant coping style, and age emerged as significant predictors of pain severity, while mediation analyses revealed that lifetime discrimination partially mediated the relationship between race/ethnicity and pain severity for racially marginalized participants, compared to non-Hispanic White participants. Furthermore, greater reliance on avoidant coping combined with greater lifetime discrimination experiences was associated with increased severity of pain.

Conclusions: The findings indicate how racism may result in worse pain outcomes in people of color, with potentially amplified adverse effects for those who engage in avoidant coping. While therapeutic interventions targeting avoidance may benefit racialized individuals, ultimately, the results highlight the critical need for large-scale policy interventions targeting racial discrimination to improve health equity and reduce the burden of pain among racialized populations.

Keywords: coping; discrimination; pain disparities; pain severity; racism; wellbeing.

Figure 1.

Moderated mediation theory. The association between race/ethnicity and pain was theorized to be mediated by exposure to discrimination, with interactions between discrimination and mental wellbeing. Control variables included participant age, gender, and negative affect.

Figure 2.

Moderated mediation of race/ethnicity on pain severity. The model depicts the association of participant race/ethnicity on pain severity (BPI Severity) through the mediator, discrimination (GEDS Lifetime), and the interaction between discrimination and mental wellbeing measures of avoidant coping (Brief COPE) and depressive symptoms (BDI-II). Control variables included participant age, gender, and PANAS Negative scores. Reference group for racial/ethnic contrasts were non-Hispanic White participants. BDI-II, Beck Depression Inventory-II; BPI, Brief Pain Inventory, Short Form; Brief COPE, Coping Orientation to Problems Experienced Inventory, Abbreviated Version; GEDS, General Ethnic Discrimination Scale; PANAS, Positive and Negative Affect Schedule. *P < .05. **P < .01. **P < .001.

Figure 3.

Interactions between discrimination and mental wellbeing on pain severity. Variables are mean centered with conditioning values at 1 standard deviation above and below the mean. BDI-II, Beck Depression Inventory-II; BPI, Brief Pain Inventory, Short Form; Brief COPE, Coping Orientation to Problems Experienced Inventory, Abbreviated Version; GEDS, General Ethnic Discrimination Scale.