Race Differences in Resilience Among Older Adults with Chronic Low Back Pain

Abstract

Introduction Racial minorities are disproportionally affected by pain. Compared to non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs) report higher pain intensity, greater pain-related disability, and higher levels of mood disturbance. While risk factors contribute to these disparities, little is known regarding how sources of resilience influence these differences, despite the growing body of research supporting the protective role of resilience in pain and disability among older adults with chronic pain. The current study examined the association between psychological resilience and pain, and the moderating role of race across these relationships in older adults with chronic low back pain (cLBP). Methods This is a secondary analysis of the Adaptability and Resilience in Aging Adults (ARIAA). Participants completed measures of resilience (ie, gratitude, trait resilience, emotional support), as well as a performance-based measure assessing lower-extremity function and movement-evoked pain. Results There were 45 participants that identified as non-Hispanic White (NHW) and 15 participants that identified as non-Hispanic Black (NHB). Race was a significant correlate of pain outcomes with NHBs reporting greater movement-evoked pain ( r = 0.27) than NHWs. After controlling for relevant sociodemographic characteristics, measures of movement-evoked pain were similar across both racial groups, F (1, 48) = 0.31, p = 0.57. Moderation analyses revealed that higher levels of gratitude ( b = −1.23, p = 0.02) and trait resilience ( b = −10.99, p = 0.02) were protective against movement-evoked pain in NHWs. In contrast, higher levels of gratitude were associated with lower functional performance in NHBs ( b = −0.13, p =0.02). Discussion These findings highlight racial differences in the relationship between resilience and pain-related outcomes among older adults with cLBP. Future studies should examine the potential benefits of targeted interventions that improve resilience and ameliorate pain disparities among racial minorities.

Bias in Musculoskeletal Pain Management and Bias-Targeted Interventions to Improve Pain Outcomes

“…In a retrospective study, Morrison et al (2021) found that Black and Hispanic residents were less likely to have pain behaviors documented or to receive analgesics than NHW residents. Morais et al (2021) found that higher levels of gratitude and trait resilience were protective against movement-evoked pain among NHW participants; however, gratitude was associated with lower functional performance in Black participants.…”

A scoping review on the methods of assessment and role of resilience on function and movement-evoked pain when experiencing a musculoskeletal injury

“…Four papers [ 18 , 42 , 44 , 45 ] provided socioeconomic demographics with the majority of participants reporting low socioeconomic status. Pooled data of 170 participants across three studies demonstrates that most participants (35.9%) had an annual income of <US $20,000.…”

“…The Roland-Morris Disability Questionnaire (RMDQ) (n = 5) and the Short Physical Performance Battery (SPPB) (n = 4) were the most common assessments tools used. The SPPB was used across a range of musculoskeletal conditions including back pain [ 44 ], knee osteoarthritis [ 18 ] and after hip fracture [ 41 ], whilst the RMDQ was used for participants with back pain [ 43 , 46 , 47 , 49 , 50 ].…”

“…The articles included in this review provided data on 5153 participants. The same pool of subjects were often used in studies with similar research teams [44][45][46][47], with these subject pools only included in the total population analysis once. Of these 5153 participants, 2059 were male, 3091 were female and 3 were unspecified.…”

Adaptability and Resilience in Aging Adults (ARIAA): protocol for a pilot and feasibility study in chronic low back pain

“…Research has been historically focused on vulnerability and risk factors (e.g., negative mood, pain catastrophizing, fear avoidance) influencing pain and functioning. This represents a significant knowledge gap as emerging literature suggests that individuals with chronic pain have the ability to exhibit resilience [ 9 – 14 ]. Conceptualized as a dynamic construct, resilience is defined as a process of adapting to adversity, threats, or significant sources of stress [ 15 ].…”