Race/Ethnicity Moderates the Association Between Psychosocial Resilience and Movement‐Evoked Pain in Knee Osteoarthritis

Abstract

ObjectiveRacial/ethnic disparities in pain are well‐recognized, with non‐Hispanic blacks (NHBs) experiencing greater pain severity and pain‐related disability than non‐Hispanic whites (NHWs). Although numerous risk factors are posited as contributors to these disparities, there is limited research addressing how resilience differentially influences pain and functioning across race/ethnicity. Therefore, this study examined associations between measures of psychosocial resilience, clinical pain, and functional performance among adults with knee osteoarthritis (OA), and assessed the moderating role of race/ethnicity on these relationships.MethodsIn a secondary analysis of the Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD‐2) study, 201 individuals with knee OA (NHB = 105, NHW = 96) completed measures of resilience (ie, trait resilience, optimism, positive well‐being, social support, positive affect) and clinical pain, as well as a performance‐based measure assessing lower‐extremity function and movement‐evoked pain.ResultsBivariate analyses showed that higher levels of psychosocial resilience were associated with lower clinical pain and disability and more optimal physical functioning. NHBs reported greater pain and disability, poorer lower‐extremity function, and higher movement‐evoked pain compared with NHWs; however, measures of psychosocial resilience were similar across race/ethnicity. In moderation analyses, higher optimism and positive well‐being were protective against movement‐evoked pain in NHBs, whereas higher levels of positive affect were associated with greater movement‐evoked pain in NHWs.ConclusionOur findings underscore the importance of psychosocial resilience on OA‐related pain and function and highlight the influence of race/ethnicity on the resilience‐pain relationship. Treatments aimed at targeting resilience may help mitigate racial/ethnic disparities in pain.

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

“…Consistent with previous findings, 3 , 44 we found that NHBs reported greater movement-evoked pain compared to NHWs; however, these differences were attenuated after controlling for clinical and sociodemographic characteristics (See Table 3 ). The causes underlying race differences in pain outcomes are complex, and the mechanisms operating on the relationship between sociodemographic factors, cultural experiences, and race are less clear.…”

“…Indeed, emerging research from our group suggests that among older adults with knee osteoarthritis, higher optimism and positive well-being are protective against movement-evoked pain (ie, pain-induced upon movement) in NHBs, whereas positive affect is associated with lower movement-evoked pain in NHWs. 3 These findings underscore the importance of identifying sources of resilience and their influence on pain and functioning across racial groups. Understanding these differences may facilitate the development of more culturally sensitive interventions that reduce racial disparities in pain and improve well-being among older adults.…”

“… 1 , 2 The symptom burden of cLBP contributes to significant impairments in psychological and physical functioning, diminishing quality of life, and increasing pain-related disability. 2 The impact of pain is greater for racial minorities, as non-Hispanic Blacks (NHBs) encounter higher rates of disabling and severe pain relative to non-Hispanic Whites (NHWs), 3 , 4 an effect which contributes to adverse psychological outcomes such as higher rates of depression, 5 , 6 disability 7 and perceived stress. 8 The high prevalence of cLBP and its adverse sequelae are particularly alarming, given the rapidly growing aging population in the United States.…”

Multisystem Resiliency as a Predictor of Physical and Psychological Functioning in Older Adults With Chronic Low Back Pain

“…Indeed, the small sample limited our ability to examine several factors, including relevant physiological/biological markers (e.g., inflammatory cytokines) (Khan et al, 2017), or demographic characteristics such as sex and race/ethnicity. Moreover, there is a need to replicate these findings in a more diverse sample, especially given growing evidence of the impact of race/ethnicity on resilience and pain-related outcomes (Bartley et al, 2019a). Inclusion of these and other diversity variables will be important considerations for future studies.…”

Adaptability and Resilience in Aging Adults (ARIAA): A Pilot and Feasibility Study in Chronic Low Back Pain

“…While factors such as anxiety and depression may increase risk for pain vulnerability, psychosocial facets such as optimism, self-e cacy, gratitude, and positive emotions are known to promote greater pain-related resilience and improve quality of life (11)(12)(13)(14). Extant research (15)(16)(17)(18) signi es that resilience (and its underlying facets) is associated with attenuated experimental pain sensitivity (19); lower pain severity, disability, and mobility impairment (16,18,20); and higher psychological functioning (21). Despite this, limited published research has examined resilience in older adults with pain.…”