Musculoskeletal pain costs over $100 billion annually in the U.S., severely impacting daily life, especially chronic low back pain. Disparities in prevalence and management, particularly for Blacks/African Americans, are exacerbated by socioeconomic, cultural, and healthcare access barriers, leading to more severe pain and functional impairments. This scoping review aimed to examine the effectiveness of community health-driven, culturally tailored self-management interventions for musculoskeletal pain in Black/African Americans. The review followed the PRISMA guidelines, with a literature search conducted across multiple databases. Articles were included based on criteria, focusing on studies that examine the effectiveness and components of such interventions. Publications from peer-reviewed journals were searched using the databases PubMed/MEDLINE, PsycINFO, CINAHL, and Scopus, employing the following search terms: "musculoskeletal pain," "chronic low back pain," "chronic neck pain," "chronic knee pain," "osteoarthritis," "self-management interventions," and "African Americans" or "Blacks", etc. A total of 9 articles were included for the review. The findings revealed that these interventions, which incorporate educational, behavioral, and physical components, show promise in reducing pain severity, improving self-efficacy, and enhancing function. The use of a community health-driven approach and cultural tailoring enhances the relevance and effectiveness of the interventions. However, research is limited by small sample sizes and short-term follow-ups, and most studies predominantly involve female participants. Conclusively, Community-driven, culturally tailored interventions can potentially improve outcomes for Blacks/African Americans suffering from chronic musculoskeletal pain. Further research is needed to explore long-term effects, address gender imbalances in study populations, and develop more comprehensive interventions considering socioeconomic and cultural factors. PERSPECTIVE: This article presents the effectiveness of community health-driven, culturally tailored self-management interventions for musculoskeletal pain in Blacks/African Americans. These community-driven, culturally tailored interventions may help clinicians be more culturally informed and improve chronic and musculoskeletal pain outcomes among Blacks/African Americans.

Purpose The purposes of this scoping review were to: (1) systematically evaluate the literature on the types and effectiveness of cannabis and cannabinoids for pain management in adults with sickle cell disease (SCD), (2) assess the effect of cannabis and cannabinoids on pain outcomes, and (3) identify research gaps. Design Systematic scoping review. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, relevant studies were identified across PubMed, CINAHL, and Cannakeys databases. Inclusion criteria were studies involving medical and recreational cannabis use in adult SCD patients addressing pain management. Exclusion criteria included studies on pediatric populations, non-English publications, or case reports. Results Of 369 articles, 12 met inclusion criteria (one clinical trial, two reviews, seven observational, one mixed-methods, and one qualitative study), revealing mixed but generally positive evidence on cannabinoid effectiveness. While some studies indicated reduced pain scores with inhaled cannabis, results varied for other pain outcomes, such as hospitalizations for vaso-occlusive crises, and raised safety concerns, particularly with synthetic cannabinoids. Conclusions Cannabinoids may help manage SCD pain, though evidence remains mixed. No studies showed exacerbation of SCD symptoms, but safety concerns warrant careful use. Clinical Implications The variability in outcomes underscores the need for personalized cannabis-based treatment plans and further research on standardized dosing and long-term safety.

BackgroundThe relationship between multidimensional chronic pain (frequency, intensity, and interference) and subjective cognitive decline remains unclear, and the roles of depression and anxiety in this relationship are still unknown.ObjectiveTo investigate depression and anxiety as mediators in the relationship between multidimensional chronic pain and subjective cognitive decline.MethodsA cross-sectional study on 10,095 older adults from the 2020 National Health Interview Survey was conducted. Parallel mediation models with bootstrapping were used to assess mediating effects.ResultsPain frequency and intensity had significant direct effects on subjective cognitive decline, while all three pain dimensions had significant indirect effects on subjective cognitive decline through depression or anxiety.ConclusionDepression and anxiety mediate, the relationship between multidimensional chronic pain and subjective cognitive decline, highlighting their role in the pathway from chronic pain to subjective cognitive decline.

Chronic low back pain (cLBP) is one of the leading causes of disability globally and represents an enormous burden to aging adults. While numerous factors contribute to cLBP, dysregulation in the hypothalamic-pituitary-adrenal axis and autonomic nervous system functioning have been implicated in its pathogenesis. It is well documented that negative psychological states can modulate biological stress responsivity in chronic pain; however, little is known regarding the influence of positive psychological factors in this relationship. The aim of this study was to examine the association between psychological risk and resilience factors with patterns of physiological stress reactivity and recovery in 60 older adults with cLBP. Participants completed measures of hope, optimism, pain catastrophizing, and perceived stress, and underwent psychophysical pain testing assessing responses to painful pressure, heat, and cold stimuli. Salivary samples were obtained prior to pain induction and at 7 time points spanning 90 minutes after pain testing terminated. To examine reactivity and recovery profiles in hypothalamic-pituitary-adrenal axis and autonomic nervous system function, samples were assayed for cortisol and alpha-amylase, respectively. Results revealed higher levels of hope and optimism were associated with increased cortisol reactivity (p's < .003) and more rapid recovery (p's = .001). Further, pain catastrophizing and perceived stress were associated with cortisol reactivity, with lower levels of these factors predicting larger increases in cortisol from baseline to peak levels (p's < .04). No significant differences in reactivity or recovery patterns emerged for alpha-amylase. Overall, findings highlight the role of psychological risk and resilience factors in modulating physiological stress reactivity. PERSPECTIVE: This article investigated whether psychosocial risk and resilience factors were associated with stress reactivity and recovery in response to laboratory-based pain testing in older adults with chronic low back pain. Results indicate that high resilience factors may be protective by modulating adrenocortical reactivity and recovery profiles.

Chronic musculoskeletal pain including knee osteoarthritis (OA) is a leading cause of disability worldwide. Previous research indicates ethnic-race groups differ in the pain and functional limitations experienced with knee OA. However, when socioenvironmental factors are included in analyses, group differences in pain and function wane. Pain-related brain structures are another area where ethnic-race group differences have been observed. Environmental and sociocultural factors e.g., income, education, experiences of discrimination, and social support influence brain structures. We investigate if environmental and sociocultural factors reduce previously observed ethnic-race group differences in pain-related brain structures. Data were analyzed from 147 self-identified non-Hispanic black (NHB) and non-Hispanic white (NHW), middle and older aged adults with knee pain in the past month. Information collected included health and pain history, environmental and sociocultural resources, and brain imaging. The NHB adults were younger and reported lower income and education compared to their NHW peers. In hierarchical multiple regression models, sociocultural and environmental factors explained 6-37% of the variance in pain-related brain regions. Self-identified ethnicity-race provided an additional 4-13% of explanatory value in the amygdala, hippocampus, insula, bilateral primary somatosensory cortex, and thalamus. In the rostral/caudal anterior cingulate and dorsolateral prefrontal cortex, self-identified ethnicity-race was not a predictor after accounting for environmental, sociocultural, and demographic factors. Findings help to disentangle and identify some of the factors contributing to ethnic-race group disparities in pain-related brain structures. Numerous arrays of environmental and sociocultural factors remain to be investigated. Further, the differing sociodemographic representation of our NHB and NHW participants highlights the role for intersectional considerations in future research.

Purpose: The purpose of this study was to characterize nurses’ attitudes toward music and implementation of music into patient care and to characterize barriers and facilitators toward the implementation of music into patient care. Design: A cross-sectional, quantitative, web-based questionnaire with minor qualitative elements. Methods: The questionnaire contained both open- and closed-ended questions. It was developed in Qualtrics and sent via email to nurses working on inpatient units at an academic medical center hospital in the southeastern United States. Findings: A total of 348 nurses responded to the questionnaire. Eighty-nine percent of nurses reported having used music in their care. The methods of implementation most employed by nurses were streaming (90%) or encouraging a patient to play music on the patient's personal device (76.8%). Eighty-eight percent of nurses reported that access to music streaming services (e.g., Spotify) would be very helpful or extremely helpful. In response to the open-ended questions, nurses indicated a lack of equipment as the primary barrier to implementing music in care. Conclusion: Nurses reported having a positive attitude toward the use of music, strongly endorsing its utility in patient care. Although most nurses reported implementing music, many nurses reported barriers and facilitators to the implementation of music in patient care.

Abstract Objective Lower socioeconomic status (SES) is a risk factor for poorer pain-related outcomes. Further, the neighborhood environments of disadvantaged communities can create a milieu of increased stress and deprivation that adversely affects pain-related and other health outcomes. Socioenvironmental variables such as the Area Deprivation Index, which ranks neighborhoods based on socioeconomic factors could be used to capture environmental aspects associated with poor pain outcomes. However, it is unclear whether the ADI could be used as a risk assessment tool in addition to individual-level SES. Methods The current study investigated whether neighborhood-level disadvantage impacts knee pain-related outcomes above sociodemographic measures. Participants were 188 community-dwelling adults who self-identified as non-Hispanic Black or non-Hispanic White and reported knee pain. Area Deprivation Index (ADI; measure of neighborhood-level disadvantage) state deciles were derived for each participant. Participants reported educational attainment and annual household income as measures of SES, and completed several measures of pain and function: Short-form McGill Pain Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, and Graded Chronic Pain Scale were completed, and movement-evoked pain was assessed following the Short Physical Performance Battery. Hierarchical linear regression analyses were used to assess whether environmental and sociodemographic measures (i.e., ADI 80/20 [80% least disadvantaged and 20% most disadvantaged]; education/income, race) were associated with pain-related clinical outcomes. Results Living in the most deprived neighborhood was associated with poorer clinical knee pain-related outcomes compared to living in less deprived neighborhoods (ps < 0.05). Study site, age, BMI, education, and income explained 11.3–28.5% of the variance across all of the individual pain-related outcomes. However, the ADI accounted for 2.5–4.2% additional variance across multiple pain-related outcomes. Conclusion The ADI accounted for a significant amount of variance in pain-related outcomes beyond the control variables including education and income. Further, the effect of ADI was similar to or higher than the effect of age and BMI. While the effect of neighborhood environment was modest, a neighborhood-level socioenvironmental variable like ADI might be used by clinicians and researchers to improve the characterization of patients’ risk profile for chronic pain outcomes.

Background and purposeWe and others have reported ethnic/race group differences in clinical pain, physical function, and experimental pain sensitivity. However, recent research indicates that with consideration for socioenvironmental factors, ethnicity/race differences become less or non-significant. Understanding of factors contributing to pain inequities are needed. Guided by the NIA and NIMHD Health Disparities Research Frameworks, we evaluate the contributions of environmental and behavioral factors on previously reported ethnic/race group differences in: (1) clinical pain, (2) physical function, and (3) experimental pain in individuals with knee pain.MethodsBaseline data from Understanding of Pain and Limitations in Osteoarthritis Disease (UPLOAD) and UPLOAD-2 studies were analyzed. Participants were adults 45 to 85 years old who self-reported as non-Hispanic white (NHW) or black (NHB) with knee pain. A health assessment and quantitative sensory testing were completed. Sociodemographics, environmental, health, clinical and experimental pain, and physical functioning measures were included in nested regressions.ResultsPooled data from 468 individuals, 57 ± 8 years of age, 63% women, and 53% NHB adults. As NHB adults were younger and reported greater socioenvironmental risk than the NHW adults, the term sociodemographic groups is used. With inclusion of recognized environmental and behavioral variables, sociodemographic groups remained a significant predictor accounting for <5% of the variance in clinical pain and physical function and <10% of variance in experimental pain.ConclusionThe incorporation of environmental and behavioral factors reduced relationships between sociodemographic groups and pain-related outcomes. Pain sites, BMI, and income were significant predictors across multiple models. The current study adds to a body of research on the complex array of factors contributing to disparities in pain-related outcomes.

Epileptogenic seizures, or status epilepticus (SE), leads to excitotoxic injury in hippocampal and limbic neurons in the kainic acid (KA) animal model of temporal lobe epilepsy (TLE). Here, we have further characterized neural activity regulated methylaminoisobutryic acid (MeAIB)/glutamine transport activity in mature rat hippocampal neurons in vitro that is inhibited by riluzole (IC50 = 1 μM), an anti-convulsant benzothiazole agent. We screened a library of riluzole derivatives and identified SKA-41 followed by a second screen and synthesized several novel chlorinated aminothiazoles (SKA-377, SKA-378, SKA-379) that are also potent MeAIB transport inhibitors in vitro, and brain penetrant following systemic administration. When administered before KA, SKA-378 did not prevent seizures but still protected the hippocampus and several other limbic areas against SE-induced neurodegeneration at 3d. When SKA-377 - 379, (30 mg/kg) were administered after KA-induced SE, acute neural injury in the CA3, CA1 and CA4/hilus was also largely attenuated. Riluzole (10 mg/kg) blocks acute neural injury. Kinetic analysis of SKA-378 and riluzoles' blockade of Ca2+-regulated MeAIB transport in neurons in vitro indicates that inhibition occurs via a non-competitive, indirect mechanism. Sodium channel NaV1.6 antagonism blocks neural activity regulated MeAIB/Gln transport in vitro (IC50 = 60 nM) and SKA-378 is the most potent inhibitor of NaV1.6 (IC50 = 28 μM) compared to NaV1.2 (IC50 = 118 μM) in heterologous cells. However, pharmacokinetic analysis suggests that sodium channel blockade may not be the predominant mechanism of neuroprotection here. Riluzole and our novel aminothiazoles are agents that attenuate acute neural hippocampal injury following KA-induced SE and may help to understand mechanisms involved in the progression of epileptic disease.

better than the original BACE model (AUC: 0.670).The model for persistent disability had an AUC of 0.812, which was also better than the original BACE model (AUC: 0.778).Utilizing only PROs with BOLD provided similar outcomes to BACE for persistent back pain and disability.This supports the external validity of these models and their potential use in clinical practice.

Chronic pain is a significant public health problem, and the prevalence and societal impact continues to worsen annually. Multiple cognitive and emotional factors are known to modulate pain, including pain catastrophizing, which contributes to pain facilitation and is associated with altered resting‐state functional connectivity in pain‐related cortical and subcortical circuitry. Pain and catastrophizing levels are reported to be higher in non‐Hispanic black (NHB) compared with non‐Hispanic White (NHW) individuals. The current study, a substudy of a larger ongoing observational cohort investigation, investigated the pathways by which ethnicity/race influences the relationship between pain catastrophizing, clinical pain, and resting‐state functional connectivity between anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (dlPFC), insula, and primary somatosensory cortex (S1). Participants included 136 (66 NHBs and 70 NHWs) community‐dwelling adults with knee osteoarthritis. Participants completed the Coping Strategies Questionnaire‐Revised Pain Catastrophizing subscale and Western Ontario and McMaster Universities Osteoarthritis Index. Magnetic resonance imaging data were obtained, and resting‐state functional connectivity was analyzed. Relative to NHW, the NHB participants were younger, reported lower income, were less likely to be married, and self‐reported greater clinical pain and pain catastrophizing ( p s < 0.05). Ethnicity/race moderated the mediation effects of catastrophizing on the relationship between clinical pain and resting‐state functional connectivity between the ACC, dlPFC, insula, and S1. These results indicate the NHB and NHW groups demonstrated different relationships between pain, catastrophizing, and functional connectivity. These results provide evidence for a potentially important role of ethnicity/race in the interrelationships among pain, catastrophizing, and resting‐state functional connectivity.

Disparities in the experience of chronic musculoskeletal pain in the United States stem from a confluence of a broad array of factors. Organized within the National Institute on Aging Health Disparity Research Framework, a literature review was completed to evaluate what is known and what is needed to move chronic musculoskeletal pain research forward specific to disproportionately affected populations. Peer-reviewed studies published in English, on human adults, from 2000 to 2019, and conducted in the United States were extracted from PubMed and Web of Science. Articles were reviewed for key words that focused on underrepresented ethnic/race groups with chronic musculoskeletal pain applying health factor terms identified in the NIAHealth Disparity Research Framework four levels of analysis: 1) environmental, 2) sociocultural, 3) behavioral, and 4) biological. A total of 52 articles met inclusion criteria. There were limited publications specific to underrepresented ethnic/race groups with chronic musculoskeletal pain across all levels with particular research gaps under sociocultural and biological categories. Current limitations in evidence may be supplemented by a foundation of findings specific to the broader topic of "chronic pain" which provides guidance for future investigations. Study designs including a focus on protective factors and multiple levels of analyses would be particularly meritorious. Perspective Chronic musculoskeletal pain unequally burdens underrepresented ethnic/race groups. In order to move research forward and to systematically investigate the complex array of factors contributing toward health disparities, an organized approach is necessary. Applying the NIA Health Disparities Research Framework, an overview of the current state of evidence specific to chronic musculoskeletal pain and underrepresented ethnic/race groups is provided with future directions identified.

Objectives: This study uses a nationally representative sample of adults to investigate racial-ethnic differences in reasons for cannabis use among those reporting past 12-month misuse of prescription opioids for pain relief. Methods: Data from the 2015-2019 National Surveys on Drug Use and Health were used to study 3,093 adults 18 to 49 years old reporting past 12-month pain-related prescription pain reliever (opioid) misuse. Logistic regressions assessed the association between past 12-month cannabis use – (non medical vs. any medical) – and multiple socio-demographic, psycho-social and drug use correlates. NSDUH analysis weights were applied to accommodate for the sampling design. Results: Half of individuals who reported misuse of prescription opioids for pain relief used cannabis in the past 12-months. In this sample of cannabis users, 87.6% (95%CI = 86.1, 88.9) used non-medically, and 12.4 (95%CI = 11.1, 13.9) used for both medical and recreational reasons. Individuals with past 12 months diagnosis of opioid use disorder were 1.8 (95%CI = 1.29, 2.63) times as likely to be medical cannabis users compared to those without a disorder. Conclusions: The findings indicate that medical cannabis might be an alternative for nearly one in eight individuals misusing pain relievers to alleviate their pain, primarily those with an opioid use disorder. Despite increased rates of cannabis use among males and non-Hispanic Whites in the general population, no gender or racial-ethnic differences were found in the selected sample. Future studies should investigate simultaneous use and the analgesic effects of co-use in this sample.

Abstract: Pain is a subjective experience and its perception and expression vary widely. Pain catastrophizing, which refers to patients' thoughts or feelings about their pain, may impact their communication of pain and nurses' subsequent response. This article discusses how nurses can more readily recognize, assess, and manage pain catastrophizing. This article explores how nurses can more readily recognize, assess, and manage pain catastrophizing, which refers to patients' thoughts or feelings about their pain.

ABSTRACT:Pain is a subjective experience and its perception and expression vary widely. Pain catastrophizing, which refers to patients' thoughts or feelings about their pain, may impact their communication of pain and nurses' subsequent response. This article discusses how nurses can more readily recognize, assess, and manage pain catastrophizing.

Burdens related to pain, smoking/nicotine dependence, and pain-smoking comorbidity disproportionately impact Black Americans, and menthol cigarette use is overrepresented among Black adults who smoke cigarettes. Menthol may increase nicotine exposure, potentially conferring enhanced acute analgesia and driving greater dependence. Therefore, the goal of the current study was to examine associations between pain, menthol cigarette use, and nicotine dependence. Data was drawn from Black adults who were current cigarette smokers (n = 1370) at Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health Study. Nicotine dependence was assessed using the Wisconsin Inventory of Smoking Dependence Motives. ANCOVA revealed that moderate/severe pain (vs. no/low pain) was associated with greater overall nicotine dependence (p < .001) and greater negative reinforcement, cognitive enhancement, and affiliative attachment smoking motives (ps < .001). Menthol smokers with moderate/severe pain also endorsed greater cigarette craving and tolerance, compared to non-menthol smokers with no/low pain (ps < .05). Findings support the notion that among Black individuals who smoke cigarettes, the presence of moderate/severe pain (vs. no/low pain) and menthol use may engender greater physical indices of nicotine dependence relative to non-menthol use. Compared to no/low pain, moderate/severe pain was associated with greater emotional attachment to smoking and greater proclivity to smoke for reducing negative affect and enhancing cognitive function. Clinical implications include the need to address the role of pain and menthol cigarette use in the assessment and treatment of nicotine dependence, particularly among Black adults. These data may help to inform evolving tobacco control policies aimed at regulating or banning menthol tobacco additives.

Chronic pain is variably associated with brain structure. Phenotyping based on pain severity may address inconsistencies. Sociodemographic groups also differ in the experience of chronic pain severity. Whether differences by chronic pain severity and/or sociodemographic groups are indicated in pain-related areas of the brain is unknown. Relations between 2 measures of chronic pain severity and brain structure via T1-weighted MRI were investigated and sociodemographic group differences explored. The observational study included 142 community-dwelling (68 non-Hispanic Black [NHB] and 74 non-Hispanic White [NHW]) adults with/at risk for knee osteoarthritis. Relationships between chronic pain severity, sociodemographic groups, and a priori selected brain structures (postcentral gyrus, insula, medial orbitofrontal, anterior cingulate, rostral middle frontal gyrus, hippocampus, amygdala, thalamus) were explored. Chronic pain severity associated with cortical thickness. NHB participants reported lower sociodemographic protective factors and greater clinical pain compared to NHWs who reported higher sociodemographic protective factors and lower clinical pain. Greater chronic pain severity was associated with smaller amygdala volumes in the NHB group and larger amygdala volumes in the NHW group. Brain structure by chronic pain stage differed between and within sociodemographic groups. Overall, chronic pain severity and sociodemographic factors are associated with pain-related brain structures. Our findings highlight the importance of further investigating social and environmental contributions in the experience of chronic pain to unravel the complex array of factors contributing to disparities. PERSPECTIVE: The study presents data demonstrating structural brain relationships with clinical pain severity, characteristic pain intensity and chronic pain stage, differ by sociodemographic groups. Findings yield insights into potential sources of previous inconsistent pain-brain relationships and highlights the need for future investigations to address social and environmental factors in chronic pain disparities research.

Objectives: This study aims to investigate racial-ethnic differences in reasons for misuse of prescription medications among a nationally representative sample of US adults. Methods: We analyzed data from the 2015-2019 National Surveys on Drug Use and Health. The study population includes US adults (18-49 years old) who reported misuse of 3 types of prescription drugs (stimulants [n = 6139], sedatives and tranquilizers [n = 5643], and pain relievers [n = 8780]) for 3 reasons: medical-only (eg, to help with pain), recreational-only (eg, to get high), or combined medical and recreational reasons. Multinomial logistic regressions assessed the association between reasons of misuse of prescription medications and self-identified race-ethnicity. Results: Misuse of the 4 types of prescription medications was primarily motivated by medical reasons (63%-80%). Compared to non-Hispanic Whites, non-Hispanic Blacks (nHB), and Hispanics (H) were less likely to report misuse of pain relievers for combined (nHB: adjusted relative risk ratio [aRRR] = 0.6, 95% confidence interval [CI]: 0.4, 0.7; H; aRRR = 0.7, 95% CI: 0.5, 0.9) or recreational reasons (nHB: aRRR = 0.8, 95% CI: 0.6, 1.0; H; aRRR = 0.7, 95% CI: 0.6, 0.9) rather than medical-only reasons. The odds of misuse of sedatives and tranquilizers for recreational-only reasons as opposed to medical-only reasons were higher among nHB (aRRR = 1.9, 95% CI: 1.3, 2.7) and H (aRRR = 1.9, 95% CI: 1.4, 2.4) than among non-Hispanic Whites. Conclusions: The increased misuse of prescription pain relievers for medical reasons among racial-ethnic minority groups demonstrates a continued need to investigate underlying structural factors driving these behaviors. The higher odds of sedative and tranquilizer misuse for recreational purposes among racial-ethnic minority groups warrant further investigation.

Chronic musculoskeletal (MSK) pain is disabling to individuals and burdensome to society. A relationship between telomere length and resilience was reported in individuals with consideration for chronic pain intensity. While chronic pain associates with brain changes, little is known regarding the neurobiological interface of resilience. In a group of individuals with chronic MSK pain, we examined the relationships between a previously investigated resilience index, clinical pain and functioning measures, and pain‐related brain structures, with consideration for sex and ethnicity/race. A cross‐sectional analysis of 166 non‐Hispanic Black and non‐Hispanic White adults, 45–85 years of age with pain ≥ 1 body site (s) over the past 3 months was completed. Measures of clinical pain and functioning, biobehavioral and psychosocial resilience, and structural MRI were completed. Our findings indicate higher levels of resilience associate with lower levels of clinical pain and functional limitations. Significant associations between resilience, ethnicity/race, and/or sex, and pain‐related brain gray matter structure were demonstrated in the right amygdaloid complex, bilateral thalamus, and postcentral gyrus. Our findings provide compelling evidence that in order to decipher the neurobiological code of chronic pain and related protective factors, it will be important to improve how chronic pain is phenotyped; to include an equal representation of females in studies including analyses stratifying by sex, and to consider other sociodemographic factors.

Objective Knee osteoarthritis (OA) is a leading source of pain and disability among older adults. Self-management (SM) strategies are recommended to manage OA symptoms. Sociodemographic and clinical characteristics, along with other factors, may influence SM utilization rate. This study sought to examine the prevalence and correlates of SM use for pain among non-Hispanic Black patients (NHB) and non-Hispanic White patients (NHW) older adults with or at risk for knee OA. Methods A secondary data analysis was conducted on the Understanding Pain and Limitations in Osteoarthritic Disease multisite observational study, which included NHB (n = 104) and NHW (n = 98) community-dwelling older adults with or at risk for knee OA. Participants completed measures of sociodemographics, pain SM use, coping, and clinical and experimental pain. Results Clinical and experimental pain were significantly greater among NHBs compared to NHWs. There were no significant differences in use of total SM by ethnicity/race. Interestingly, multiple linear regression revealed that clinical and experimental pain indices, as well as coping, number of pain sites, age, and sex were differentially associated with total SM use between NHBs and NHWs. There were significant ethnicity/race by type of pain management interaction effects for pain measures. Conclusion SM is common among older adults with or at risk for knee OA pain, and the prevalence of SM does not differ by ethnicity/race, but many guideline-recommended interventions for OA are underutilized. Importantly, different factors were associated with the use of SM, highlighting distinct biopsychosocial mechanisms contributing to SM use in NHBs and NHWs.