Skip to main content

Advertisement

SpringerLink
Log in

The association of perceived discrimination with low back pain

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

A handful of recent studies have documented perceived discrimination as a correlate of poor physical and mental health status among ethnic and racial minority groups. To date, however, despite a proliferation of research on ethnic disparities in the severity and impact of a number of persistent pain conditions, there have been no reports on associations between perceived discrimination and pain-related symptoms. Using data from a national survey (the National Survey of Midlife Development in the United States; MIDUS), we explore the relationships between perceived discriminatory events and the report of back pain among African-American and white men and women. As expected, African-American participants reported substantially greater perceptions of discrimination than white participants. Moreover, in models that included a variety of physical and mental health variables, episodes of major lifetime discriminatory events were the strongest predictors of back pain report in African-Americans, and perceived day-to-day discrimination was the strongest predictor of back pain report specifically in African-American women. Among white participants, perceptions of discrimination were minimally related or unrelated to back pain. To our knowledge, these are the first data documenting an association between perceived discrimination and report of back pain; the fact that perceptions of discrimination were stronger predictors than physical health variables highlights the potential salience and adverse impact of perceived discrimination in ethnic and racial minority groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Amaro, H., & Zambrana, R. E. (2000). Criollo, mestizo, mulato, latinegro, indigena, white, or black? The US Hispanic/Latino population and multiple responses in the 2000 census. American Journal of Public Health, 90, 1724–1727.

    Article  PubMed  Google Scholar 

  • Anderson, K. O., Mendoza, T. R., Valero, V., Richman, S. P., Russell, C., Hurley, J., et al. (2000). Minority cancer patients and their providers: Pain management attitudes and practice. Cancer, 88, 1929–1938. doi:10.1002/(SICI)1097-0142(20000415)88:8≤1929::AID-CNCR23≥3.0.CO;2-2.

    Article  PubMed  Google Scholar 

  • Ang, D. C., Ibrahim, S. A., Burant, C. J., Siminoff, L. A., & Kent, K. C. (2002). Ethnic differences in the perception of prayer and consideration of joint arthroplasty. Medical Care, 40, 471–476. doi:10.1097/00005650-200206000-00004.

    Article  PubMed  Google Scholar 

  • Banks, K. H., Kohn-Wood, L. P., & Spencer, M. (2006). An examination of the African American experience of everyday discrimination and symptoms of psychological distress. Community Mental Health Journal, 42, 555–570. doi:10.1007/s10597-006-9052-9.

    Article  PubMed  Google Scholar 

  • Brage, S., Sandanger, I., & Nygard, J. F. (2007). Emotional distress as a predictor for low back disability: A prospective 12-year population-based study. Spine, 32, 269–274. doi:10.1097/01.brs.0000251883.20205.26.

    Article  PubMed  Google Scholar 

  • Brawley, O. W. (1998). Prostate cancer and black men. Seminars in Urologic Oncology, 16, 184–186.

    PubMed  Google Scholar 

  • Brim, O., Baltes, P., Bumpass, L., Cleary, P., Featherman, D., Hazzard, W., et al. (2000). National SAurvey of Midlife Development in the United States 1995–6, Inter-University Consortium for Political and Social Research.

  • Brody, G. H., Chen, Y. F., Murry, V. M., Ge, X., Simons, R. L., Gibbons, F. X., et al. (2006). Perceived discrimination and the adjustment of African American youths: A five-year longitudinal analysis with contextual moderation effects. Child Development, 77, 1170–1189. doi:10.1111/j.1467-8624.2006.00927.x.

    Article  PubMed  Google Scholar 

  • Brondolo, E., Thompson, S., Brady, N., Appel, R., Cassells, A., Tobin, J. N., et al. (2005). The relationship of racism to appraisals and coping in a community sample. Ethnicity and Disease, 15, S5–S9.

    PubMed  Google Scholar 

  • Brooks, P. M. (2006). The burden of musculoskeletal disease––a global perspective. Clinical Rheumatology, 25, 778–781. doi:10.1007/s10067-006-0240-3.

    Article  PubMed  Google Scholar 

  • Broudy, R., Brondolo, E., Coakley, V., Brady, N., Cassells, A., Tobin, J. N., et al. (2007). Perceived ethnic discrimination in relation to daily moods and negative social interactions. Journal of Behavioral Medicine, 30, 31–43. doi:10.1007/s10865-006-9081-4.

    Article  PubMed  Google Scholar 

  • Bruehl, S., Chung, O. Y., & Burns, J. W. (2006a). Anger expression and pain: An overview of findings and possible mechanisms. Journal of Behavioral Medicine, 29, 593–606. doi:10.1007/s10865-006-9060-9.

    Article  PubMed  Google Scholar 

  • Bruehl, S., Chung, O. Y., & Burns, J. W. (2006b). Trait anger and blood pressure recovery following acute pain: Evidence for opioid-mediated effects. International Journal of Behavioral Medicine, 13, 138–146. doi:10.1207/s15327558ijbm1302_5.

    Article  PubMed  Google Scholar 

  • Bruehl, S., Chung, O. Y., Burns, J. W., & Biridepalli, S. (2003). The association between anger expression and chronic pain intensity: Evidence for partial mediation by endogenous opioid dysfunction. Pain, 106, 317–324. doi:10.1016/S0304-3959(03)00319-1.

    Article  PubMed  Google Scholar 

  • Bruehl, S., Chung, O. Y., Burns, J. W., & Diedrich, L. (2007). Trait anger expressiveness and pain-induced beta-endorphin release: Support for the opioid dysfunction hypothesis. Pain, 130(3), 208–215.

    Article  PubMed  Google Scholar 

  • Burns, J. W. (2006). Arousal of negative emotions and symptom-specific reactivity in chronic low back pain patients. Emotion (Washington, D.C.), 6, 309–319. doi:10.1037/1528-3542.6.2.309.

  • Burns, J. W., Bruehl, S., & Quartana, P. J. (2006). Anger management style and hostility among patients with chronic pain: Effects on symptom-specific physiological reactivity during anger- and sadness-recall interviews. Psychosomatic Medicine, 68, 786–793. doi:10.1097/01.psy.0000238211.89198.e4.

    Article  PubMed  Google Scholar 

  • Campbell, C. M., Edwards, R. R., & Fillingim, R. B. (2005). Ethnic differences in responses to multiple experimental pain stimuli. Pain, 113, 20–26. doi:10.1016/j.pain.2004.08.013.

    Article  PubMed  Google Scholar 

  • Carey, T. S., & Garrett, J. M. (2003). The relation of race to outcomes and the use of health care services for acute low back pain. Spine, 28, 390–394. doi:10.1097/00007632-200302150-00016.

    Article  PubMed  Google Scholar 

  • Casagrande, S. S., Gary, T. L., LaVeist, T. A., Gaskin, D. J., & Cooper, L. A. (2007). Perceived discrimination and adherence to medical care in a racially integrated community. Journal of General Internal Medicine, 22, 389–395. doi:10.1007/s11606-006-0057-4.

    Article  PubMed  Google Scholar 

  • Clark, R., Anderson, N. B., Clark, V. R., & Williams, D. R. (1999). Racism as a stressor for African Americans. A biopsychosocial model. The American Psychologist, 54, 805–816. doi:10.1037/0003-066X.54.10.805.

    Article  PubMed  Google Scholar 

  • Danielsson, A. J., & Nachemson, A. L. (2003). Back pain and function 22 years after brace treatment for adolescent idiopathic scoliosis: A case-control study-part I. Spine, 28, 2078–2085. doi:10.1097/01.BRS.0000084268.77805.6F.

    Article  PubMed  Google Scholar 

  • Dionne, C. E. (2005). Psychological distress confirmed as predictor of long-term back-related functional limitations in primary care settings. Journal of Clinical Epidemiology, 58, 714–718. doi:10.1016/j.jclinepi.2004.12.005.

    Article  PubMed  Google Scholar 

  • Dyrbye, L. N., Thomas, M. R., Eacker, A., Harper, W., Massie, F. S., Jr, Power, D. V., et al. (2007). Race, ethnicity, and medical student well-being in the United States. Archives of Internal Medicine, 167, 2103–2109. doi:10.1001/archinte.167.19.2103.

    Article  PubMed  Google Scholar 

  • Edwards, R. R., Bingham, C. O., III, Bathon, J., & Haythornthwaite, J. A. (2006a). Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis and Rheumatism, 55, 325–332. doi:10.1002/art.21865.

    Article  PubMed  Google Scholar 

  • Edwards, R. R., Doleys, D. M., Fillingim, R. B., & Lowery, D. (2001a). Ethnic differences in pain tolerance: Clinical implications in a chronic pain population. Psychosomatic Medicine, 63, 316–323.

    PubMed  Google Scholar 

  • Edwards, R. R., & Fillingim, R. B. (1999). Ethnic differences in thermal pain responses. Psychosomatic Medicine, 61, 346–354.

    PubMed  Google Scholar 

  • Edwards, C. L., Fillingim, R. B., & Keefe, F. (2001b). Race, ethnicity and pain. Pain, 94, 133–137. doi:10.1016/S0304-3959(01)00408-0.

    Article  PubMed  Google Scholar 

  • Edwards, R. R., Goble, L., Kwan, A., Kudel, I., McGuire, L., Heinberg, L., et al. (2006b). Catastrophizing, pain, and social adjustment in scleroderma: Relationships with educational level. The Clinical Journal of Pain, 22, 639–646. doi:10.1097/01.ajp. 0000210918.26159.94.

    Article  PubMed  Google Scholar 

  • Edwards, R. R., Moric, M., Husfeldt, B., Buvanendran, A., & Ivankovich, O. (2005). Ethnic similarities and differences in the chronic pain experience: A comparison of African American, Hispanic, and white patients. Pain Medicine, 6, 88–98. doi:10.1111/j.1526-4637.2005.05007.x.

    Article  PubMed  Google Scholar 

  • Enthoven, P., Skargren, E., Carstensen, J., & Oberg, B. (2006). Predictive factors for 1-year and 5-year outcome for disability in a working population of patients with low back pain treated in primary care. Pain, 122, 137–144. doi:10.1016/j.pain.2006.01.022.

    Article  PubMed  Google Scholar 

  • Gee, G. C., Spencer, M. S., Chen, J., & Takeuchi, D. (2007). A nationwide study of discrimination and chronic health conditions among Asian Americans. American Journal of Public Health, 97, 1275–1282. doi:10.2105/AJPH.2006.091827.

    Article  PubMed  Google Scholar 

  • Gifford, A. L., Collins, R., Timberlake, D., Schuster, M. A., Shapiro, M. F., Bozzette, S. A., et al. (2000). Propensity of HIV patients to seek urgent and emergent care. HIV cost and services utilization study consortium. Journal of General Internal Medicine, 15, 833–840. doi:10.1046/j.1525-1497.2000.91136.x.

    Article  PubMed  Google Scholar 

  • Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R. B., et al. (2003). The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain Medicine, 4, 277–294. doi:10.1046/j.1526-4637.2003.03034.x.

    Google Scholar 

  • Harrell, J. P., Hall, S., & Taliaferro, J. (2003). Physiological responses to racism and discrimination: An assessment of the evidence. American Journal of Public Health, 93, 243–248.

    Article  PubMed  Google Scholar 

  • Hastie, B. A., Riley, J. L., & Fillingim, R. B. (2005). Ethnic differences and responses to pain in healthy young adults. Pain Medicine, 6, 61–71. doi:10.1111/j.1526-4637.2005.05009.x.

    Article  PubMed  Google Scholar 

  • Jakobsson, U., & Hallberg, I. R. (2002). Pain and quality of life among older people with rheumatoid arthritis and/or osteoarthritis: A literature review. Journal of Clinical Nursing, 11, 430–443. doi:10.1046/j.1365-2702.2002.00624.x.

    Article  PubMed  Google Scholar 

  • Jordan, M. S., Lumley, M. A., & Leisen, J. C. (1998). The relationships of cognitive coping and pain control beliefs to pain and adjustment among African-American and Caucasian women with rheumatoid arthritis. Arthritis Care and Research, 11, 80–88. doi:10.1002/art.1790110203.

    Article  PubMed  Google Scholar 

  • Katz, J. N. (2006). Lumbar disc disorders and low-back pain: Socioeconomic factors and consequences. The Journal of Bone and Joint Surgery. American Volume, 88(Suppl 2), 21–24. doi:10.2106/JBJS.E.01273.

    Google Scholar 

  • Keefe, F. J., Abernethy, A. P., & Campbell, C. (2005). Psychological approaches to understanding and treating disease-related pain. Annual Review of Psychology, 56, 601–630. doi:10.1146/annurev.psych.56.091103.070302.

    Article  PubMed  Google Scholar 

  • Keefe, F. J., Rumble, M. E., Scipio, C. D., Giordano, L. A., & Perri, L. M. (2004). Psychological aspects of persistent pain: Current state of the science. Journal of Pain, 5, 195–211. doi:10.1016/j.jpain.2004.02.576.

    Article  PubMed  Google Scholar 

  • Keefe, F. J., Smith, S. J., Buffington, A. L., Gibson, J., Studts, J. L., & Caldwell, D. S. (2002). Recent advances and future directions in the biopsychosocial assessment and treatment of arthritis. Journal of Consulting and Clinical Psychology, 70, 640–655. doi:10.1037/0022-006X.70.3.640.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., DuPont, R. L., Berglund, P., & Wittchen, H. U. (1999). Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. The American Journal of Psychiatry, 156, 1915–1923.

    PubMed  Google Scholar 

  • Landrine, H., & Klonoff, E. A. (2000). Racial discrimination and cigarette smoking among Blacks: Findings from two studies. Ethnicity and Disease, 10, 195–202.

    PubMed  Google Scholar 

  • Latthe, P., Latthe, M., Say, L., Gulmezoglu, M., & Khan, K. S. (2006). WHO systematic review of prevalence of chronic pelvic pain: A neglected reproductive health morbidity. BMC Public Health, 6, 177. doi:10.1186/1471-2458-6-177.

    Article  PubMed  Google Scholar 

  • Lee, H., Bahler, R., Chung, C., Alonzo, A., & Zeller, R. A. (2000). Prehospital delay with myocardial infarction: The interactive effect of clinical symptoms and race. Applied Nursing Research, 13, 125–133. doi:10.1053/apnr.2000.7652.

    Article  PubMed  Google Scholar 

  • Levin, S., Sinclair, S., Veniegas, R. C., & Taylor, P. L. (2002). Perceived discrimination in the context of multiple group memberships. Psychological Science, 13, 557–560. doi:10.1111/1467-9280.00498.

    Article  PubMed  Google Scholar 

  • Linton, S. J. (2005). Do psychological factors increase the risk for back pain in the general population in both a cross-sectional and prospective analysis? European Journal of Pain (London, England), 9, 355–361. doi:10.1016/j.ejpain.2004.08.002.

    Google Scholar 

  • List, J. M. (2005). Histories of mistrust and protectionism: Disadvantaged minority groups and human-subject research policies. The American Journal of Bioethics, 5, 53–56. doi:10.1080/15265160590927741.

    Article  PubMed  Google Scholar 

  • Macfarlane, G. J., McBeth, J., & Silman, A. J. (2001). Widespread body pain and mortality: Prospective population based study. BMJ (Clinical Research Ed.), 323, 662–665. doi:10.1136/bmj.323.7314.662.

  • Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91, 1869–1876.

    PubMed  Google Scholar 

  • Mays, V. M., Cochran, S. D., & Barnes, N. W. (2007). Race, race-based discrimination, and health outcomes among African Americans. Annual Review of Psychology, 58, 201–225. doi:10.1146/annurev.psych.57.102904.190212.

    Article  PubMed  Google Scholar 

  • McBeth, J., Silman, A. J., & Macfarlane, G. J. (2003). Association of widespread body pain with an increased risk of cancer and reduced cancer survival: A prospective, population-based study. Arthritis and Rheumatism, 48, 1686–1692. doi:10.1002/art.10973.

    Article  PubMed  Google Scholar 

  • McCracken, L. M., & Eccleston, C. (2005). A prospective study of acceptance of pain and patient functioning with chronic pain. Pain, 118, 164–169. doi:10.1016/j.pain.2005.08.015.

    Article  PubMed  Google Scholar 

  • McCracken, L. M., & Vowles, K. E. (2006). Acceptance of chronic pain. Current Pain and Headache Reports, 10, 90–94. doi:10.1007/s11916-006-0018-y.

    Article  PubMed  Google Scholar 

  • McCracken, L. M., Vowles, K. E., & Gauntlett-Gilbert, J. (2007). A prospective investigation of acceptance and control-oriented coping with chronic pain. Journal of Behavioral Medicine, 30, 339–349. doi:10.1007/s10865-007-9104-9.

    Article  PubMed  Google Scholar 

  • McWilliams, L. A., Goodwin, R. D., & Cox, B. J. (2004). Depression and anxiety associated with three pain conditions: Results from a nationally representative sample. Pain, 111, 77–83. doi:10.1016/j.pain.2004.06.002.

    Article  PubMed  Google Scholar 

  • Noh, S., Kaspar, V., & Wickrama, K. A. (2007). Overt and subtle racial discrimination and mental health: Preliminary findings for Korean immigrants. American Journal of Public Health, 97, 1269–1274. doi:10.2105/AJPH.2005.085316.

    Article  PubMed  Google Scholar 

  • Norris, C. M., Ghali, W. A., Saunders, L. D., Brant, R., Galbraith, D., Faris, P., et al. (2006). Ordinal regression model and the linear regression model were superior to the logistic regression models. Journal of Clinical Epidemiology, 59, 448–456. doi:10.1016/j.jclinepi.2005.09.007.

    Article  PubMed  Google Scholar 

  • Piette, J. D., Bibbins-Domingo, K., & Schillinger, D. (2006). Health care discrimination, processes of care, and diabetes patients’ health status. Patient Education and Counseling, 60, 41–48. doi:10.1016/j.pec.2004.12.001.

    Article  PubMed  Google Scholar 

  • Rahim-Williams, F. B., Riley, J. L., III, Herrera, D., Campbell, C. M., Hastie, B. A., & Fillingim, R. B.(2007). Ethnic identity predicts experimental pain sensitivity in African Americans and Hispanics. Pain, 129(1–2), 177–184.

  • Reddy, S., Shapiro, M., Morton, R., Jr., & Brawley, O. W. (2003). Prostate cancer in black and white Americans. Cancer and Metastasis Reviews, 22, 83–86. doi:10.1023/A:1022216119066.

    Article  PubMed  Google Scholar 

  • Rogers, A., & Allison, T. (2004). What if my back breaks? Making sense of musculoskeletal pain among South Asian and African-Caribbean people in the North West of England. Journal of Psychosomatic Research, 57, 79–87. doi:10.1016/S0022-3999(03)00570-1.

    Article  PubMed  Google Scholar 

  • Schouten, B. C., & Meeuwesen, L. (2006). Cultural differences in medical communication: A review of the literature. Patient Education and Counseling, 64, 21–34. doi:10.1016/j.pec.2005.11.014.

    Article  PubMed  Google Scholar 

  • Shavers, V. L., & Shavers, B. S. (2006). Racism and health inequity among Americans. Journal of the National Medical Association, 98, 386–396.

    PubMed  Google Scholar 

  • Siefert, K., Finlayson, T. L., Williams, D. R., Delva, J., & Ismail, A. I. (2007). Modifiable risk and protective factors for depressive symptoms in low-income African American mothers. The American Journal of Orthopsychiatry, 77, 113–123. doi:10.1037/0002-9432.77.1.113.

    Article  PubMed  Google Scholar 

  • Smith, M. T., Edwards, R. R., Robinson, R. C., & Dworkin, R. H. (2004). Suicidal ideation, plans, and attempts in chronic pain patients: Factors associated with increased risk. Pain, 111, 201–208. doi:10.1016/j.pain.2004.06.016.

    Article  PubMed  Google Scholar 

  • Taylor, T. R., Williams, C. D., Makambi, K. H., Mouton, C., Harrell, J. P., Cozier, Y., et al. (2007). Racial discrimination and breast cancer incidence in US Black women: The Black women’s health study. American Journal of Epidemiology, 166, 46–54. doi:10.1093/aje/kwm056.

    Article  PubMed  Google Scholar 

  • Thapa, S. B., & Hauff, E. (2005). Gender differences in factors associated with psychological distress among immigrants from low- and middle-income countries––findings from the Oslo Health Study. Social Psychiatry and Psychiatric Epidemiology, 40, 78–84. doi:10.1007/s00127-005-0855-8.

    Article  PubMed  Google Scholar 

  • Thomas, K. S., Bardwell, W. A., Ancoli-Israel, S., & Dimsdale, J. E. (2006). The toll of ethnic discrimination on sleep architecture and fatigue. Health Psychology, 25, 635–642. doi:10.1037/0278-6133.25.5.635.

    Article  PubMed  Google Scholar 

  • Turk, D. C. (1996). Biopsychosocial perspective on chronic pain. In R. J. Gatchel & D. C. Turk (Eds.), Psychological approaches to pain management: A practitioner’s handbook (pp. 3–32). New York: Guilford Press.

  • Turk, D. C. (2002). Chronic non-malignant pain patients and health economic consequences. European Journal of Pain (London, England), 6, 353–355. doi:10.1016/S1090-3801(02)00024-1.

    Google Scholar 

  • Wamala, S., Bostrom, G., & Nyqvist, K. (2007a). Perceived discrimination and psychological distress in Sweden. The British Journal of Psychiatry, 190, 75–76. doi:10.1192/bjp.bp.105.021188.

    Article  PubMed  Google Scholar 

  • Wamala, S., Merlo, J., Bostrom, G., & Hogstedt, C. (2007b). Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. Journal of Epidemiology and Community Health, 61, 409–415. doi:10.1136/jech.2006.049999.

    Article  PubMed  Google Scholar 

  • Wang, P. S., Berglund, P., & Kessler, R. C. (2000). Recent care of common mental disorders in the United States: Prevalence and conformance with evidence-based recommendations. Journal of General Internal Medicine, 15, 284–292. doi:10.1046/j.1525-1497.2000.9908044.x.

    Article  PubMed  Google Scholar 

  • Williams, D. R. (1999). Race, socioeconomic status, and health. The added effects of racism and discrimination. Annals of the New York Academy of Sciences, 896, 173–188. doi:10.1111/j.1749-6632.1999.tb08114.x.

    Article  PubMed  Google Scholar 

  • Williams, D. R., Neighbors, H. W., & Jackson, J. S. (2003). Racial/ethnic discrimination and health: Findings from community studies. American Journal of Public Health, 93, 200–208.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Anesthesiology, Perioperative, and Pain Medicine, and Psychiatry, Harvard Medical School, Pain Management Center, Brigham and Women’s Hospital, 850 Boylston Street, Suite 302, Chestnut Hill, MA, 02467, USA

    Robert R. Edwards

Authors
  1. Robert R. Edwards
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert R. Edwards.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Edwards, R.R. The association of perceived discrimination with low back pain. J Behav Med 31, 379–389 (2008). https://doi.org/10.1007/s10865-008-9160-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-008-9160-9

Keywords

Search

Navigation