The Intersectionality of Racial Discrimination and Chronic Pain Stigma Among Patients with Chronic Low Back Pain

Both race-based discrimination and chronic pain stigma are associated with poor health outcomes, including worse pain and psychological distress. However, it is unclear the extent to which the intersectionality of discrimination and stigma impact pain-related outcomes. Using data from the Examining Racial And SocioEconomic Disparities (ERASED) in Chronic Low Back Pain study, we examined the intersectionality of race-based discrimination and chronic pain stigma in relation to pain-related outcomes among individuals with chronic low back pain (cLBP). Participants (N=230, Mage=45, 56% female; 61% Black, 39% White) completed validated measures of the experience of racial discrimination, internalized chronic pain stigma, clinical pain severity and interference, depression, and stress. An intersectional discrimination and stigma composite variable was created, and participants were categorized as either high (27%), moderate (45%), or low (28%). Analyses of covariance controlling for race and gender were conducted to examine group differences in pain severity and interference, depression, and stress. Results revealed that Black participants were more likely to be in the high and moderate intersectional stigma groups (p<.05). Participants with high intersectional stigma reported significantly greater pain severity and interference, depression, and stress compared to moderate and low intersectional stigma (ps<.05). These results suggest that the experience of both racial discrimination and chronic pain stigma may synergistically perpetuate the impact of clinical pain and psychological distress more profoundly than experiencing either one alone. Future interventions targeting intersectional stigma may play an important role in addressing pain-related symptoms in patients with cLBP.