Purpose: Previous research has shown that African Americans report higher levels of pain severity and disability associated with chronic pain compared to Non-Hispanic Whites (NHW) using self-reported data. In this analysis, we aimed to further explore racial disparities in the subjective experience of pain using objectively measured behavioral data among individuals with chronic pain.
Method: Individuals with self-reported moderate to severe chronic pain (n=5,832) and no chronic pain (n=4,204) were eligible to enroll in a currently ongoing, prospective 1-year, virtual study. To understand the association between self reported pain and behavioral data, we conducted two separate multivariable linear regressions using study baseline survey data and behavioral data 30 days prior to enrollment. The dependent variables were 1) pain severity and 2) pain interference (on a scale from 0–10) using questions adapted from the Brief Pain Inventory—Short Form for the chronic pain subgroup. A race variable was constructed from a list of race and ethnicity categories. Analysis was restricted to participants with no more than 7 consecutive days of missing activity data. Models were adjusted for person-level median daily step count aggregated over the month prior to enrollment. Age, sex, education, income, and BMI were included as additional covariates.
Result: Among chronic pain participants, 2,021 had sufficient activity data for analysis (NHW = 1,734; African American = 79; biracial African American = 35, other race = 173). Relative to NHW participants, African Americans reported significantly greater average pain severity (β=.81, p=<.001) and pain interference (β=.46, p=.042), adjusting for median daily step count and additional covariates. Median daily step count was negatively associated with pain severity (β=2.3e5, p<.01) and pain interference (β=6.2e5, p<.001), adjusting for race and additional covariates.
Conclusion: Holding objectively measured activity levels constant, African Americans with chronic pain reported greater levels of pain severity and pain interference compared to NHWs. Our findings add to a growing body of evidence indicating that African Americans are disproportionately burdened by chronic pain above and beyond their activity levels. Elevated levels of pain severity may contribute to poor symptom management observed in the literature among this population. Future analysis will further examine the utility of novel, behavioral data as a potential digital measure for pain severity and burden among diverse individuals with chronic pain.