The impact of stressful life events on centralized pain and pain intensity: A combined model examining the mediating roles of anger and perceived injustice among racially minoritized adults with chronic pain
One page on PainSci cites Jin 2024: Chronic Pain and Inequality
PainSci commentary on Jin 2024: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
A new study in the journal Pain linked chronic pain to the kinds of stressful life events that are probably more common in people affected by racism, and the results also imply that anger and perceived injustice make the pain worse.
Interesting. But this research needs a strong nerdy warning: ⚠️ Caution, may contain harmful assumptions about causality.
We’ve known for ages that stressful experiences are strongly associated with chronic pain, but the mechanisms are still murky, and racial minorities have been virtually ignored in that research. Jin and Yarns tried to close that gap a little, examining the link in several hundred Black, Latin, and Asian people.
They were also looking for psychological factors that might tinker with the strength of that link, specifically anger and perceived injustice. So they not only reported pain in those who’d had stressful life events, but even more in those were the most pissed off about them.
Unfortunately, a study like this can’t show that social injustice and its psychological consequences are actually “causing” chronic pain. Trying to suss out how variables are related (mediators, moderators) is putting the cart before the horse when we don’t understand the casual relationships in the first place, which can’t be determined by looking at a group of people at one point in time (cross-sectional data). Researchers tend to pay lip service to their limitations, but wink wink, nudge nudge imply the causality that they believe in anyway.
And so Jin and Yarns make a recommendation like this:
This could guide psychological intervention to focus on anger and perceived injustice especially when addressing centralized pain.
Yes, it could, but “could” is doing too much work there. We should probably be really careful about saying to people — or even “just” implying, which is how most gaslighting works — that their outrage over injustice is hurting them until we are really sure that is actually a thing. Because it might well be wrong, and because it would just be more injustice.
The arrow of causality may well point the other way: that is, the pain causes anger and frustration in proportion to the intensity of the awful experiences and poor healthcare caused by clashes with systemic racism.
Common issues and characteristics relevant to this paper: ?Scientific papers have many common characteristics, flaws, and limitations, and many of these are rarely or never acknowledged in the paper itself, or even by other reviewers. I have reviewed thousands of papers, and described many of these issues literally hundreds of times. Eventually I got sick of repeating myself, and so now I just refer to a list common characteristics, especially flaws. Not every single one of them applies perfectly to every paper, but if something is listed here, it is relevant in some way. Note that in the case of reviews, the issue may apply to the science being reviewed, and not the review itself.
- Exaggeration in the direction of a more interesting result (e.g. speculating about causality in data that only shows correlation).
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
Stressful life events are highly associated with chronic pain. Yet, research is needed to identify the psychological mechanisms that link life adversity and pain, especially studies that test comprehensive models, recruit racially diverse samples, and measure varied pain-related symptoms. This study examined the relationship between stressful life events and pain in a racially diverse sample and tested the potential mediating roles of both anger and perceived injustice. Both centralized pain symptoms and pain intensity were outcomes. Analyses consisted of two cross-sectional, mediation models among 673 adults with self-reported chronic pain who were racially diverse (Black: n = 258; Latine: n = 254; Asian American: n = 161). Results indicated a positive relationship between stressful life events and centralized pain symptoms (b = 2.53, p <.001) and pain intensity (b = 0.20, p <.001). In parallel mediation analyses, anger (b = 0.91, 95% CI = 0.67, 1.17) and perceived injustice (b = 0.86, 95% CI = 0.64, 1.11) acted as partial mediators on centralized pain symptoms. Also, anger (b = 0.05, 95% CI = 0.03, 0.08) and perceived injustice (b = 0.11, 95% CI = 0.08, 0.14) acted as full mediators on pain intensity. The combined psychosocial variables accounted for 51% of centralized pain symptoms and 26% of pain intensity. Findings suggest that psychosocial factors are significantly associated to pain outcomes. Future research is needed to investigate exposure to adversity in life, anger, and perceived injustice together as psychosocial mechanisms of pain symptoms.
PERSPECTIVE: Among racially minoritized adults with chronic pain, this article presents empirical evidence that stressful life events, anger, and perceived injustice are associated with centralized pain symptoms and pain intensity. This could guide psychological intervention to focus on anger and perceived injustice especially when addressing centralized pain.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.
- Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. Holden 2023 The Lancet Rheumatology.
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.