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

Abstract

Experiences of racism occur across a continuum from denial of services to more subtle forms of discrimination and exact a significant toll. These multilevel systems of oppression accumulate as chronic stressors that cause psychological injury conceptualized as racism-based traumatic stress (RBTS). RBTS has overlapping symptoms with posttraumatic stress disorder (PTSD) with the added burden that threats are constantly present. Chronic pain is a public health crisis that is exacerbated by the intersection of racism and health inequities. However, the relationship between RBTS and pain has not yet been explored. To highlight how these phenomena are interlinked, we present Racism ExpoSure and Trauma AccumulatiOn PeRpetuate PAin In-equiTIes-AdVocating for ChangE (RESTORATIVE); a novel conceptual model that integrates the models of racism and pain and demonstrates how the shared contribution of trauma symptoms (e.g., RBTS and PTSD) maintains and perpetuates chronic pain for racialized groups in the United States. Visualizing racism and pain as "two halves of the same coin," in which the accumulative effects of numerous events may moderate the severity of RBTS and pain, we emphasize the importance of within-group distinctiveness and intersectionality (overlapping identities). We call on psychologists to lead efforts in applying the RESTORATIVE model, This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.Anna M. Hood https://orcid.org/0000-0002-7213-1179 The authors would like to thank Joshua Maddux at the University of Cincinnati for his assistance with visualizing the RESTORATIVE conceptual model.

Innovative treatment formats, technologies, and clinician trainings that improve access to behavioral pain treatment for youth and adults

“…People who experience race-based trauma and stress (RBTS) are also disproportionately at higher risk for developing chronic pain. Developing and tailoring treatments that are sensitive to the needs of specific racialized groups and address cultural, structural, and institutional factors that result in RBTS and pain ( 101 ). Intersecting factors, such as stigma and medical mistrust, toward behavioral pain treatments and clinicians are also important to address to increase treatment engagement.…”

How psychologists can help achieve equity in health care—advancing innovative partnerships and models of care delivery: Introduction to the special issue.

“…The second theme, intersections between social drivers and the determinants of health , examines how structural forces—as reflected in policies and practices around debt, housing, built environment, food, and employment—work through psychological processes to initiate, drive, and maintain health inequities. Hood et al (2023) explore how multilevel systems of oppression accumulate as chronic stressors through racism-based traumatic stress, leading to posttraumatic stress disorder symptoms. Based on this premise, the Racism Exposure and Trauma Accumulation Perpetuate Pain Inequities—Advocating for Change model illustrates the integration of racism and pain and how this shared contribution of trauma symptoms generates chronic pain for racialized groups in the United States.…”

Acceptability and Feasibility of a Pain and Depressive Symptoms Management Intervention in Middle-Aged and Older African American Women

“…Self-regulation theory involves 2 tenets: (a) participants manage their response to situations based on their experiences (experiences with pain and depression) and knowledge of an event and (b) participants’ goals are to maintain comfort and decrease the negative effects of an illness (pain and/or depression) on their lives ( 25 , 26 ). African American women have had experiences within health care, experiences in society, and specific experiences with access and use of pain management strategies that have shaped their responses to their pain and their mental health ( 10 , 29–31 ). In this study, we are testing the feasibility of the DAPPER intervention and working with participants who will set their goals based on their experiences and existing knowledge about pain and depressive symptoms, and their experiences and preferences surrounding treatment.…”