People in pain report more frequent perceived discrimination than those without pain, study finds

People in pain are more like to report more frequent perceived discrimination than those without pain, according to a 2022 study published in Pain. (Photo by Mike Jones)

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.” This population with perceived discrimination predicts “greater depressive symptoms and loneliness over 6-year follow-up,” the researchers wrote.

Scott and her colleagues Dr. Ruth Hackett and Prof. Sarah E. Jackson from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London reported that people in pain were more likely to be:

• Older
• Female
• Less wealthy
• Non-white
• Not married
• A smoker
• Sedentary
• Overweight

However, the researchers wrote that the sample population was “overwhelmingly White British, so racial discrimination was not the most prominent form reported here.”

How was the study done?

In an interview with Massage & Fitness, Hackett said that they used the dataset English Longitudinal Study of Ageing (ELSA), which is designed to represent the demographics of England. They used baseline data from a group in 2010-11, which was the only group that discrimination was assessed, and follow-up data in 2016-17.

“Of course, there are parts of England that are much more ethnically diverse, but in the middle and older age group, ELSA is representative of England as a whole,” she said. She added ELSA has been updated with more ethnic diversity in more recent datasets, but these data were not available at the time they were working on the study.

Hackett said that she, Scott, and Jackson realized there was a need for high-quality, longitudinal evidence since previous studies have used cross-sectional designs, had mostly small sample sizes, and focused on racial and ethnic discrimination in the U.S.

Longitudinal studies follow the same group of people over a long period of time where scientists collect data at several or many points in time to observe changes and developments. Cross-sectional studies collect data from different groups or individuals at a single point in time to get a “snapshot” of the population’s characteristics and relationships between variables.

“We cannot make causal inferences due to our study design. Casual inferences cannot be made using observational epidemiological data,” Hackett said. “The temporal ordering of discrimination predicting later depression and loneliness in people with pain increases the likelihood that the relationship is causal, but we cannot claim this due to the observational nature of our data. A different study design would be needed to make causal claims.”

Hackett said they also found that discrimination at one point in time predicted new onset of pain six years later in some people who were initially pain free. 

“It is also possible that those who have pain may experience increases in discrimination over time,” she said. “However, we could not test this here as at the time we wrote the paper discrimination was only assessed at one time point in ELSA.”

Limitations

Scott, Jackson, and Hackett wrote that the participants’ perceived discrimination were based on subjective encounters rather than objective encounters with discrimination. Self-reported discrimination based on past experiences “may be affected by recall bias,” they wrote, adding that they did not not have information on pain duration, the causes of pain, or disability.

Hackett said that clinicians should understand that discriminatory experiences have many negative health impacts for people in pain, such as greater depressive symptoms, higher levels of loneliness, lower life satisfaction, and poorer ratings of their own physical health in the short term.

“For clinicians, it is important to understand that perceptions of discrimination may increase the likelihood of developing new onset pain in those who were initially pain free,” she said.