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      Everyday Discrimination in Adults with Knee Pain: The Role of Perceived Stress and Pain Catastrophizing

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          Research indicates pain-related disparities in the impact of knee osteoarthritis (OA) across both sex and ethnicity/race. While several factors likely contribute to these disparities, experiences of discrimination are associated with poor OA-related pain, disability, and functional performance. However, the mechanisms that mediate experiences of discrimination and OA-related outcomes are unclear. The current cross-sectional study examined the associations between everyday experiences of discrimination and clinical pain, disability and functional performance among non-Hispanic Black (NHB) and non-Hispanic White (NHW) persons with or at risk of knee OA and assessed the serial mediated model of perceived stress and pain catastrophizing on these relationships in women only.

          Patients and Methods

          Participants were 188 community-dwelling adults who presented with unilateral or bilateral knee pain and screened positive for clinical knee pain. Participants completed several measures including experiences of discrimination, Perceived Stress Scale, Coping Strategies Questionnaire-Revised (CSQ-R): Pain Catastrophizing subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Graded Chronic Pain Scale (GCPS), and Short Physical Performance Battery (SPPB).


          As compared to NHW participants, NHB individuals reported experiencing significantly higher levels of discrimination ( F(1, 175)=26.660, p<0.001), greater levels of pain catastrophizing ( F(1, 180)=12.919, p<0.001), higher levels of clinical pain and disability, and lower levels of physical function ( ps<0.05). However, perceived stress was positively correlated with discrimination in the NHW group only (NHW females: r=0.40, p<0.01; NHW males: r=0.37, p<0.05). Further, perceived stress and pain catastrophizing mediated the relationship between discrimination and outcome variables (WOMAC pain, GCPS interference [pain disability], and SPPB function) in female participants after controlling for relevant sociodemographic variables (study site, age, race, income, and body mass index).


          These results may have implications for the treatment of perceived stress and catastrophizing as a means to reduce the negative impact of experiences of discrimination on the experience of chronic pain, particularly for women.

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          Most cited references 33

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          Racial and ethnic disparities in pain: causes and consequences of unequal care.

          The purpose of our review is to evaluate critically the recent literature on racial and ethnic disparities in pain and to determine how far we have come toward reducing and eliminating disparities in pain. We examined peer-reviewed research articles published between 1990 and early 2009 that focused on racial and ethnic disparities in pain in the United States. The databases used were PubMed, Medline, Scopus, CINAHL, and PsycInfo. The probable causes of minority group disparities in pain are discussed, along with suggested strategies for eliminating pain-related disparities. This review reveals the persistence of racial and ethnic disparities in acute, chronic, cancer, and palliative pain care across the lifespan and treatment settings, with minorities receiving lesser quality pain care than non-Hispanic whites. Although health and health care disparities attract local, state, and federal attention, disparities in pain care continue to be missing from publicized public health agendas and health care reform plans. Ensuring optimal pain care for all is critically important from a public health and policy perspective. A robust research program on disparities in pain is needed, and the results must be successfully translated into practices and policies specifically designed to reduce and eliminate disparities in care. This review evaluates the recent literature on racial and ethnic disparities in pain and pain treatment. Racial and ethnic disparities in acute pain, chronic cancer pain, and palliative pain care continue to persist. Rigorous research is needed to develop interventions, practices, and policies for eliminating disparities in pain.
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            Perceiving Discrimination Against One's Gender Group has Different Implications for Well-Being in Women and Men

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              Risk factors and burden of osteoarthritis.

              Osteoarthritis (OA) is one of the most common joint disorders worldwide. Its prevalence is increasing because of the growing aging of the population in developed and developing countries as well as an increase in risk factors leading to OA, particularly obesity and a sedentary lifestyle. Risk factors of OA can be divided into person-level factors (age, gender, obesity, genetics and diet) and joint-level factors (injury, malalignment and abnormal loading of the joints) that interact in a complex manner. OA is the 11th cause of disability in the world. It is responsible for activity limitations, particularly walking, and affects participation and quality of life. Patients with OA are at greater risk of all-cause mortality, particularly for cardiovascular diseases, than the general population. This excess mortality is closely associated with disability level. Consequently, strategies to reduce burden through primary and secondary prevention programs are increasingly important.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                01 May 2020
                : 13
                : 883-895
                [1 ]Department of Biobehavioral Nursing Science, University of Florida , Gainesville, Florida, United States
                [2 ]Department of Aging and Geriatric Research, University of Florida , Gainesville, Florida, United States
                [3 ]Pain Research and Intervention Center of Excellence (PRICE) , Gainesville, Florida, United States
                [4 ]Oakland University, School of Nursing , Rochester, MI, United States
                [5 ]Department of Psychology, University of Alabama at Birmingham , Birmingham, Alabama, United States
                [6 ]University of Alabama at Birmingham, Division of Clinical Immunology & Rheumatology , Birmingham, Alabama, United States
                [7 ]Department of Medicine, University of Florida , Gainesville, Florida, United States
                [8 ]Department of Biostatistics, University of Alabama at Birmingham , Birmingham, Alabama, United States
                [9 ]University of Florida, Community Dentistry and Behavioral Science , Gainesville, Florida, United States
                Author notes
                Correspondence: Ellen L Terry Department of Biobehavioral Nursing Science, University of Florida , PO Box 100197, GainesvilleFL 32610-0197 Tel (+352) 273-6441 Email elterry@ufl.edu
                © 2020 Terry et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 3, Tables: 7, References: 55, Pages: 13
                Research funding and support provided by NIH/NIA Grants R37AG033906 (RBF) and R01AG054370 (KTS); UF CTSA Grant UL1TR001427 and UAB CTSA Grant UL1TR001417 from the NIH Center for Advancing Translational Sciences; 1K22NS102334 and 1P30AG059297 provided to the University of Florida and McKnight Brain Institute Career Development Award (ELT), minority supplement provided to the University of Florida (JSC), NIH Training Grants TL1TR001418 provided to the University of Alabama at Birmingham (KAT); NIH/NIA Grant R00AG052642 provided to the University of Florida (EJB).
                Original Research


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