Disparities in Chronic Pain Experience and Treatment History Among Persons With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study

Abstract

Objective: To determine disparities in pain severity, pain interference, and history of pain treatment for non-Hispanic Whites, non-Hispanic Blacks, and Hispanics with traumatic brain injury (TBI) and chronic pain. Setting: Community following discharge from inpatient rehabilitation. Participants: A total of 621 individuals with medically documented moderate to severe TBI who had received acute trauma care and inpatient rehabilitation (440 non-Hispanic Whites, 111 non-Hispanic Blacks, and 70 Hispanics). Design: A multicenter, cross-sectional, survey study. Main Measures: Brief Pain Inventory; receipt of opioid prescription; receipt of nonpharmacologic pain treatments; and receipt of comprehensive interdisciplinary pain rehabilitation. Results: After controlling for relevant sociodemographic variables, non-Hispanic Blacks reported greater pain severity and greater pain interference relative to non-Hispanic Whites. Race/ethnicity interacted with age, such that the differences between Whites and Blacks were greater for older participants (for severity and interference) and for those with less than a high school education (for interference). There were no differences found between the racial/ethnic groups in the odds of having ever received pain treatment. Conclusions: Among individuals with TBI who report chronic pain, non-Hispanic Blacks may be more vulnerable to difficulties managing pain severity and to interference of pain in activities and mood. Systemic biases experienced by many Black individuals with regard to social determinants of health must be considered in a holistic approach to assessing and treating chronic pain in individuals with TBI.

Characterization and Treatment of Chronic Pain After Traumatic Brain Injury—Comparison of Characteristics Between Individuals With Current Pain, Past Pain, and No Pain: A NIDILRR and VA TBI Model Systems Collaborative Project

“…While we found several significant sociodemographic differences between those with current chronic pain, past pain, and no pain, the effect sizes were small and therefore may not be clinically meaningful. This lack of difference may be related to the bivariate approach that we took in describing the sample where these factors may not alone impact whether someone identifies as having current, past, or no chronic pain, especially given that when looking within a subgroup reporting chronic pain disparities were found in reports of the experience of pain 15. However, those with current chronic pain did have significantly worse functional outcomes, with medium effect sizes, as measured by the FIM, DRS, and GOS-E. Further research is needed to determine the nature of this relationship between functional outcomes and the experience of chronic pain, as well as exploration of multivariate models where subgroups may be identified.…”

“…In a recent study of a subsample of participants ( n = 621) with chronic pain and TBI from the current study, non-Hispanic Blacks reported greater pain severity and greater pain interference compared with Whites, even after controlling for sociodemographic variables. Older age and less than high school education were also associated with worse pain 15. In the general population, older age, female sex, and lower education have been found to be associated with the experience of both acute pain and chronic pain 16,17…”

Social Determinants of Health and Traumatic Brain Injury: Implications for Rehabilitation Service Delivery and Outcomes

“…For example, several studies revealed racial disparities in TBI care and outcomes. 7,8,10,11 However, race and ethnicity are socially constructed categories that serve as surrogate measures of historical and structural marginalization that may shape TBI care and recovery in myriad, dynamic, and mutually reinforcing ways. 20 As such, including indicators of race and ethnicity alone may be necessary, yet insufficient, for understanding the specific mechanisms underlying disparities in TBI service delivery and recovery.…”

“…Their data indicated that risk for death by suicide, drug overdose, and opioid overdose was substantially higher among military members who self-identified as “other,” a racial category that may reflect minoritized individuals whose self-conception of racial identity is outside the bounds of standard categories (eg, multiracial). In a study of individuals with moderate-severe TBI and chronic pain, Sander et al8 examined racial disparities in chronic pain-related treatment, pain severity, and pain-related disability. While the authors found no disparities in treatment history, non-Hispanic Black individuals had more severe pain and greater pain-related disability relative to non-Hispanic White individuals.…”

“…Although findings presented add to evidence of disparities in TBI care and outcomes across SDoH, what continues to be urgently needed is empirical support for purported theories explaining such disparities—many of which were advanced by authors of studies included in this issue. For example, several studies revealed racial disparities in TBI care and outcomes 7,8,10,11. However, race and ethnicity are socially constructed categories that serve as surrogate measures of historical and structural marginalization that may shape TBI care and recovery in myriad, dynamic, and mutually reinforcing ways 20.…”