Black women with chronic pain experience more psychological distress

Oct 17 2005

Black women with chronic pain experience more psychological distress, physical impairments and post-traumatic stress disorder than white women with chronic pain, a finding that researchers say should help lead to a narrowing of the gap in the treatment of chronic pain between black and white women.

New research from the University of Michigan Health System, published in the current issue of the Journal of the National Medical Association, suggests that black women with chronic pain have particular needs that should be addressed through the access to and quality of pain care.

"Although more than one in five Americans live with chronic pain, women are more likely to suffer from chronic pain conditions than men. Overall, their pain complaints receive less attention than the pain complaints from men. What we have found in this research is that there are further differences in the chronic pain experience between black and white women," says Carmen R. Green, M.D. "This study has significant public health implications as well as significant socio-economic and familial implications when studying and managing chronic pain in black women.

"In addition to ensuring adequate access to quality pain care and improving pain assessment, optimizing pain management has the tremendous potential to reduce the mental health gap between black and white women with chronic pain," says Green, associate professor in the U-M Medical School's Department of Anesthesiology and pain specialist at the U-M Health System's Center for Interventional Pain Medicine.

The study involved responses from 1,192 women with chronic pain, about 91 percent of them white and 9 percent of black. Black women in the study were more likely to report disability due to pain (44 percent versus 37 percent), and to say that pain interfered with recreational (8 percent versus 7 percent), sexual (7.4 percent versus 6.1 percent), social (7 percent versus 6 percent) and other activities.

Black women in the study also were more likely to report psychological distress due to pain, with significantly higher scores of post-traumatic stress disorder and depression. But the picture of the depression scores changed when disability, pain severity and affective distress were accounted for; with those measures factored in, black women were significantly less likely to show signs of depression than white women.

That is an important distinction, Green says, that could have important implications in how black women are treated for the physical and psychological distress related to chronic pain.

The study is the first to show that black women report more functional impairment, more post-traumatic stress disorder and less depression than white women when both have chronic pain, Green notes. The racial differences, however, were not found when measuring the effect of the chronic pain on their family and home functions, pain severity or affective distress.

"We found that disability mediates the race-depression relationship, such that higher disability yields more emotional impairment in black women when compared to whites," Green says. "Due to the economic, social and emotional impact that physical disability and emotional impact that physical disability and emotional impairment have on the lives and families of women with chronic pain, these findings can have a considerable effect on treating and studying black women with chronic pain."

Green has conducted many studies related to chronic pain in minorities, which have consistently shown disparities in pain care and health for minorities. One study found that African Americans may be disproportionately missing out on effective treatment for their chronic pain; read more at www.med.umich.edu/opm/newspage/2003/racialpain.htm.

She also has found that adults under the age of 50 who have chronic pain may be less able to cope with their condition and more prone to associated depression than their elders. Read more at www.med.umich.edu/opm/newspage/2005/pain.htm.

In addition to Green, the other author on the paper was S. Khady Ndao-Brumblay, Pharm. D., MSc., senior research associate in the U-M Health System Department of Anesthesiology's Research Division.