The Intersectionality of Chronic Pain Stigma and Racial Discrimination in Black and White Adults with Chronic Low Back Pain

Objective: We examined the intersection between chronic pain stigma and racial discrimination, separately among Black and White U.S. adults with chronic low back pain.

Methods: Participants completed measures of chronic pain stigma, lifetime experiences of racial discrimination, pain severity and interference. A composite variable representing the intersectionality of stigma and discrimination was created, and Black and White participants were separately categorized into 4 groups. Black participants were categorized as: 1) high discrimination/high stigma, 2) high discrimination/low stigma, 3) low discrimination/high stigma, and 4) low discrimination/low stigma. White participants were categorized as: 1) any discrimination/high stigma, 2) any discrimination/low stigma, 3) no discrimination/high stigma, and 4) no discrimination/low stigma.

Results: Black participants reported more frequent experiences of racial discrimination than White participants (p<.05), but there was not a racial difference in chronic pain stigma (p>.05). Among Black participants, those in the high discrimination/high stigma and low discrimination/high stigma groups reported greater pain severity and interference than those in the high discrimination/low stigma and low discrimination/low stigma groups (p<.05). Among White participants, those in the any discrimination/high stigma group reported greater pain severity and interference than those in the no discrimination/low stigma group (p<.05), but there were no differences in pain severity or interference between the any discrimination/no stigma and no discrimination/high stigma groups (p>.05).

Conclusion: Our findings suggest that the relationship of intersectional chronic pain stigma and racial discrimination with pain is nuanced and differs across racial groups.