Applying an intersectional framework to characterize chronic pain disparities one year following traumatic spinal...

Area of Science:

• Neuroscience
• Public Health
• Health Services Research

Background:

• Chronic pain affects nearly 70% of individuals post-traumatic spinal cord injury (SCI), often leading to disability.
• Existing research on SCI recovery disparities is more robust than that on chronic pain, with limited studies examining the intersectional impact of social determinants.
• Prior studies often used smaller cohorts and analyzed social determinants in isolation, failing to capture their combined effects on chronic pain outcomes.

Purpose of the Study:

• To investigate the intersectional disparities in chronic pain severity and interference among adults with traumatic SCI.
• To identify modifiable mediators contributing to these disparities in pain outcomes.
• To inform the development of targeted interventions for equitable pain management post-SCI.

Main Methods:

• Retrospective cohort study utilizing the US Spinal Cord Injury Model Systems database (n=3,514 adults with traumatic SCI).
• Exposures included race/ethnicity, annual income, and education level, analyzed for intersectional effects.
• Outcomes measured were pain severity (numeric rating scale) and pain interference (SF-12), with adjusted statistical models and causal mediation analyses.

Main Results:

• Non-Hispanic Black, lower-income, and lower-education participants reported significantly higher pain severity and more frequent severe pain interference (p<0.0001).
• Intersectional analysis revealed that Non-Hispanic Black, low-income, low-education participants experienced substantially higher pain severity and odds of severe pain interference compared to their counterparts (q<0.0001).
• Mobility, community participation (days out-of-house), insurance status, and perceived health significantly mediated pain disparities (ACME 0.158-0.312 for severity, 0.017-0.043 for interference; all q<0.001).

Conclusions:

• Chronic pain following traumatic SCI disproportionately affects individuals from socially disadvantaged backgrounds.
• Intersectional analysis reveals significant disparities in pain severity and interference, underscoring the cumulative impact of multiple disadvantages.
• Modifiable mediators, including functional status and access to resources, present potential targets for interventions aimed at reducing inequities in chronic pain management after SCI.