The relationship of sociodemographic and psychological variables with chronic pain variables in a low-income population

Abstract

Chronic pain is a pervasive condition that is complicated by economic, educational, and racial disparities. This study analyzes key factors associated with chronic pain within an understudied and underserved population. The sample is characterized by a triple disparity with respect to income, education/literacy, and racial barriers that substantially increase the vulnerability to the negative consequences of chronic pain. The study examined the pretreatment data of 290 participants enrolled in the Learning About My Pain trial, a randomized controlled comparative effectiveness trial of psychosocial interventions (B.E.T., Principal Investigator, Patient-Centered Outcomes Research Institute Contract No. 941; clinicaltrials.gov identifier NCT01967342) for chronic pain. Hierarchical multiple regression analyses evaluated the relationships among sociodemographic (sex, age, race, poverty status, literacy, and education level) and psychological (depressive symptoms and pain catastrophizing) variables and pain interference, pain severity, and disability. The indirect effects of depressive symptoms and pain catastrophizing on the sociodemographic and pain variables were investigated using bootstrap resampling. Reversed mediation models were also examined. Results suggested that the experience of chronic pain within this low-income sample is better accounted for by psychological factors than sex, age, race, poverty status, literacy, and education level. Depressive symptoms and pain catastrophizing mediated the relationships between age and pain variables, whereas pain catastrophizing mediated the effects of primary literacy and poverty status. Some reversed models were equivalent to the hypothesized models, suggesting the possibility of bidirectionality. Although cross-sectional findings cannot establish causality, our results highlight the critical role psychological factors play in individuals with chronic pain and multiple health disparities.

Persistent pain associated with socioeconomic and personal factors in a Sami and Non-Sami population in Norway: an analysis of SAMINOR 2 survey data

“…Musculoskeletal pain has been shown to increase with age, with a tendency to diminish in the oldest populations [41]. Other studies have also found that higher age did not predict pain in the elderly [26,42]. The proportion of elderly women with pain (Sami 39.5% and non-Sami 50.8%) is remarkable compared to the findings of a Swedish study, in which 64.5% of women aged > 60 years reported pain [43].…”

Chronic pain health literacy: A scoping review of existing instruments

“…Most studies were conducted in the USA (n = 5) and Germany (n = 4); outpatient clinics were the most frequent setting. Legend: HL, health literacy; N, number of studies included for data abstraction; RCT, randomized controlled trial; a referred to as primary literacy [18,32,33] or as general literacy [34] rather than HL; b there were slight differences in the definition of HL contained in the individual studies.…”

“…The Wide Range Achievement Test-4 (WRAT-4) tested the participants' reading level, i.e. their basic ability to read common vocabulary words [18,32,33], and so did the revised Slosson Oral Reading Test (SORT-R) [34]. Two instruments tested condition-specific knowledge:…”

“…Several studies used literacy instruments solely to screen patients and to ensure they met the determined inclusion criteria. Specifically, this was the case in studies involving low socioeconomic groups [18,33,34], in which a certain minimum literacy level was necessary in order to ensure participants' understanding of the required procedures. Finally, two newly developed questionnaires (the HELP and COHEP questionnaires) were used in order to examine the interaction between individual-level characteristics and contextual factors [12,19,41].…”

“…vocabulary and health knowledge) as a domain of HL, others view it only as a predisposing factor for HL [13]. Some experts differentiate between HL and other basic skills, such as reading, writing, listening, oral communication, and the ability to use math (numeracy), sometimes referred to as "primary literacy", which are important skills in any health care setting [13,18]. Moreover, the traditional understanding of HL as an individual-level construct has recently been challenged, and a broader and more complex model that emphasizes contextual factors of the health care system has been embraced [10,14,19,20].…”