Socioeconomic disparities in chronic low back pain

Abstract

Chronic pain is a widespread public health problem that affects at least 37% of U.S. adults. Low back pain (LBP) is the most common type of pain and results in over $100 billion each year in total direct and indirect (e.g., lost wages, reduced productivity) costs in the U.S. Chronic LBP (cLBP) is associated with limitations in physical function, work or school activities, and social activities, resulting in substantial impacts on individuals and families. The prevalence of back pain is higher among women, older adults and those with lower levels of education and a lower annual income. Literature reviews often document racial/ethnic disparities in pain treatment due to issues within the medical system, attitudes and beliefs of health care providers, and patient factors that result from each individual's pain experience. The biopsychosocial model conceptualizes the individual experience of pain with interrelated causes and manifestations in physical (e.g., genetics, injuries), psychological (e.g., depression, pain beliefs), and social (e.g., social support, health behaviors) dimensions. Common of assessments of cLBP include measures of pain intensity and measures of functional limitations. This research aims to explore associations of the seriousness of LBP with multiple sociodemographic characteristics. Two clinical research trials enrolled a diverse population to participant in cLBP research. All 415 participants completed baseline questionnaires, including measures of LBP intensity and LBP-related dysfunction, before randomization and participation began. The majority of participants were female, non-Hispanic black, and had an annual income <$20,000. This study population had a high level of pain intensity and LBP-related dysfunction, although the two outcomes were only moderately correlated. Two multivariate logistic regression models, one for each outcome) revealed different sets of predictors, although race/ethnicity, education, and employment status were present in both final models. LBP is a complex condition that requires differences in seriousness to be considered in relation to the multiple facets of the biopsychosocial model. Differences in seriousness of pain can in part be attributed to variability in perceptions and reports of patients. Patient perceptions as a result of coping strategies, behaviors, and perceived racial discrimination are discussed. Pain intensity and related function are important and interacting measures of cLBP in both clinical and research settings. Assessment of functional limitation holds value for predicting important disability outcomes such as the ability to work. LBP intensity ratings may reflect the direct and indirect impact of LBP treatment on psychological and social experiences of chronic pain. Medical professionals must acquire comprehensive knowledge about health disparities, cultural influences, and the role of individual behavioral characteristics in order to adequately create patient-centered treatment plans.