Does having perceived discrimination increase the risk of chronic pain? Some researchers think so.
Perceived discrimination is a person’s subjective experience of unfair treatment or negative attitudes based on their ethnicity, race, gender, age, body size, disability, and other characteristics. Discrimination is also defined as “process by which a member, or members, of a socially defined group is, or are, treated differently because of his/her/their membership of that group.”
While there is much research since the 1990s that find a strong association between perceived discrimination and psychological distress, there is no known study that examines the long-term relationship between perceived discrimination and chronic pain development, with psychological distress as a mediator between those two.
However, in 2017, a team of scientists from University of California Berkeley started this investigation by digging through data collected by the National Survey of Midlife in the United States (MIDUS) from 2004-06 and 2013-14.
Lead researcher Dr. Timothy Brown found that the top four discrimination characteristics were gender, age, height/weight, and race. While race was ranked as relatively low when all the data from 2004-06 are pooled together, it was ranked high when a sample of African-Americans from Milwaukee, Wisconsin, was taken. However, this data cannot be extrapolated to the 2013-14 group because in the 2004-06 group, about 19% of the sample population suffered from “moderate-to-severe psychological distress,” while the other group has about 33%.
How the study was done
The study estimated that there are 4.1 million people over age 40 suffer from chronic pain because of their experience with discrimination.
“The MIDUS is a survey collected in a very rigorous manner and is designed to be representative of adults in midlife in the U.S. It also follows the same individuals over time,” Brown said in the email to Massage & Fitness Magazine. “Data from the MIDUS are used extensively in scientific research. We choose to use the MIDUS because it follows individuals over time, making it possible for us to statistically determine a causal pathway from past discrimination through psychological distress to current chronic pain.”
The study did not specify the type of chronic pain because the researchers wanted to look at chronic pain from a broader neurobiological system that can affect any part of the body.
“Future research is being designed to answer the question of whether there is variation in discrimination-based chronic pain in terms of where chronic pain may present itself. I suspect that such pain will tend to present itself more in some areas of the body (e.g. low back and neck) than in other areas of the body,” Brown said.
Overall, the study added that a lifetime of perceived discrimination—the micro-nuances many people face regularly—can take a toll on many people’s stress and increase their risk of developing chronic pain.
“Older individuals who experienced more discrimination over their lifetime do have a higher risk of experiencing pain sensitivity—other things equal—and the likelihood of experiencing more discrimination would probably be higher for those located in regions of the U.S. with a higher prevalence of racism,” Brown said. “[With] other things equal, an older person would likely have experienced more of both types of discrimination: Daily and lifetime. The measures are different.”
Brown said that daily discrimination measurements measure how frequently poor treatment occurs in ordinary situations due to discrimination, such as how often people are treated as less intelligent, more dishonest, or not considered a “good” person. In constrast, the measure of lifetime discrimination measures whether discrimination can have a major life impact, such as getting fired from a job, not getting hired or promoted, denied scholarships or bank loans, and similar events.
Limitations
One major limitation of the study is that there is a higher retention rate among women, whites, married people, and those with higher education and already in good health. Brown and his colleagues wrote that this does not “impact the internal validity of our study” and their findings may be “understated” because the sample “reflects a population that experiences less discrimination than the general U.S. population.”
Brown suggested that clinicians and manual therapists should first find out if the patient has a chronic pain diagnosis “that is rooted in an actual physical disease process,” which may cause the initial bout of psychological distress but is not the root cause.
“In contrast, a person diagnosed with something, such as non-specific low back pain (back pain that has no known pathoanatomical cause), does not have a problem rooted in a diagnosed physical disease process…although their pain is very real,” Brown said. “Both classes of people will benefit from massage [therapy], but to the extent that a client’s pain is either accentuated by psychological distress or rooted in psychological distress, there is a great value to encouraging clients to process the issues underlying their stress.”
“Our next steps are to broaden our research beyond the question of discrimination causing psychological distress that can result in chronic pain,” Brown continued. “We plan to look at any uncontrollable stressor that may result in psychological distress, and thus, result in chronic pain. We are also developing machine learning models that can predict who will have chronic pain a decade in the future so that we can develop early prevention protocols.”
The broader picture
More recent studies have found similar or limited evidence that perceived discrimination is strongly associated with chronic pain.
- A 2024 study of 154 Syrian refugees who lived in Norway since the late 2010s found that nearly 30% of them “sometimes or often experienced one type of discrimination.” However, the researchers found “no relationship between perceived discrimination and [self-related health] and chronic pain.
- A 2025 study of 401 Black Americans found higher scores on each of the surveyed psychosocial risk factors (i.e., pain avoidance, pain fusion, experiential avoidance, pain catastrophizing, and pain anxiety) were “significantly associated with greater pain intensity and pain interference.” The researchers concluded that perceived discrimination was associated with “greater pain interference at higher levels of pain fusion [surgery] and pain anxiety and was not associated with pain interference at lower levels of pain fusion and pain anxiety.”
- Similar to Brown’s study, a 2022 study of 5,871 people in England found those with pain “are more likely to report discrimination than those without pain, and this experience is associated with increased depression and loneliness.”
Brown said that while much of chronic pain is based on chronic disease, much of chronic pain is “based in the ordinary stressors of life.”
“Developing protocols to prevent and relieve chronic pain that results from stress would improve the lives of millions of people,” Brown said. “I have seen people completely disabled from chronic pain become virtually pain free when they have dealt with their underlying stress issues. Standardizing a protocol to bring people relief could help millions.”
First published Nov 9, 2018
Updated: Aug. 20, 2025
Nick Ng, BA
Nick Ng is the editor of Massage & Fitness Jounal and the managing editor for My Neighborhood News Network.
An alumni from San Diego State University with a bachelor’s degree in graphic communications, Nick had completed his massage therapy training at International Professional School of Bodywork in San Diego in 2014. In 2021, he earned an associate’s degree in journalism at Palomar College.
When he gets a chance, he enjoys weightlifting at the gym, salsa dancing, and exploring new areas in the Puget Sound area in Washington state.
