“Ooh, You Got to Holler Sometime:” Pain Meaning and Experiences of Black Older Adults

Abstract

Throughout the history of the United States, the Black pain experience has been widely ignored and diminished, by media, medicine, and science. Convergent evidence demonstrates that Black adults shoulder a disproportionate burden of chronic pain and related disability. A structural racism lens shows how conditions such as residential segregation, economic deprivation, experiences of discrimination, and inferior access to high-quality medical care contribute to persistent pain in Black adults, worsen its impact, and impede its effective management. In addition to the negative physical consequences of daily pain, the emotional, social, and spiritual distress caused by unmet pain needs can significantly diminish quality of life. These factors collectively contribute to complex pain meanings that center around dependence and defeat and are countered through social engagement, spiritual coping, and meaningful activity.Consequently, despite reporting moderate to severe daily pain and an increased frequency of catastrophizing-that is, negative emotional responses to pain and perceived exaggeration-Black older adults often report high levels of adaptive coping as evidenced by continued engagement in activities. The following chapter examines the meaning of pain for Black older adults both within and outside of the medical establishment, and in the context of implicit racial bias. The authors examine challenges of effective assessment and treatment, and identify strategies Black older adults engage in to effectively cope with pain and prevent what many fear-becoming dependent on others. Finally, we highlight the need for culturally responsive pain management interventions to effectively address the complex meanings ascribed to pain by Black

What Does Disability Justice Require of Antimicrobial Stewardship?

“…For example, danger and criminality are associated with men of color with disabilities, 37 particularly those with intellectual and developmental disabilities, psychiatric disabilities, and substance use disorders, 37,38,39 and higher tolerance for pain is associated with Black people, as evidenced by the disproportionate undertreatment of pain in Black patients with chronic pain. 40,41,42 Conclusion A DJ perspective on antimicrobial stewardship entails diagnostic stewardship that prioritizes clarification of presumptive diagnoses of infection in vulnerable patients, clinician education led by disabled people, and data collection incorporating disability status as part of intersectional analyses of antimicrobial stewardship practices, each of which promotes anti-ableist practices and more equitable health care for disabled people. Communication with patients about their symptoms, medical history, and goals for care is essential, particularly among multiply marginalized patients, even and especially if it takes additional steps to find the appropriate support.…”

Factors Affecting Pain Management Self-Advocacy in Women Aged 65 and Older with Breast Cancer

“…Adults with cancer who are aged 65 and older often adopt a passive approach when communicating new onset acute pain or undermanaged chronic pain to healthcare providers (Brunello et al, 2019), presenting another challenge for their adequate pain management. This passive behavior can result from fears of adverse effects from opioid analgesia such as addiction and death from overdose (Graczyk et al, 2018) and their tendency to accept pain as an unavoidable pitfall of aging, especially adults aged 65 and older belonging to racial and ethnic minority groups (Bierman et al, 2018, Robinson-Lane et al, 2022. Reluctance of adults with cancer who are aged 65 or older to discuss pain with their healthcare providers is associated with multiple factors including female gender, advanced cancer stage, location of primary cancer site, poorer performance status, and higher number of comorbidities (Brunello et al, 2019).…”

Racism exposure and trauma accumulation perpetuate pain inequities—advocating for change (RESTORATIVE): A conceptual model.

“…In relation to RBTS, more recent theories highlight that people from racialized groups must manage overt racist encounters and microstressors that can trigger stress-based physiological and psychological responses over time, and they must flexibly choose between "active" (e.g., calling out discriminatory bias) or more "passive" (e.g., being silent) coping strategies depending on the situation often with little warning or time to make a decision, which may differ depending on their racialized coping self-efficacy (Anderson & Stevenson, 2019) and what is needed for optimal for pain coping (Robinson-Lane et al, 2021). For racialized individuals experiencing chronic pain, after months or years of obstacles and not receiving adequate pain treatment regardless of actions they may take (Meints et al, 2016), they may instead use stoicism (i.e., enduring pain or without displaying feelings and without complaint) as a pain coping strategy (Booker, 2016).…”