Disparities in Chronic Pain Highly Prevalent Among Multiracial Groups in the US

Racial and ethnic disparities in chronic pain were found to be more prevalent than previously recognized, with a higher prevalence among Native American and multiracial adults, according to study findings published in Pain.

Researchers assessed chronic pain disparities among the major racial and ethnic groups in the US and highlighted the unmet needs in pain prevention and management.

For the study, data were collected from the National Health Interview Survey (NHIS), the leading source of health and health disparities in the US. Researchers used 6 measures (severe, high-impact chronic, widespread, persistent for >3 months, persistent for >6 months, and any pain) to determine the prevalence of pain among White, Black, Hispanic, Asian, Native American and multiracial adults.

The study population included individuals with a mean age of 46.8 years; 51.8% were women. Demographic and socioeconomic covariates differed significantly across the racial and ethnic groups (all P <.001).

Most participants reported any pain (51.0%), followed by 6-month (20.0%) and 3-month (19.6%) persistent pain, and then widespread (11.6%), high-impact (7.7%) and severe (6.4%) pain.

Stratified by race and ethnicity, multiracial adults most commonly reported any pain (57.1%) and Asian adults reported the least pain (35.3%). For severe pain, American Indian and Alaska Native (AIAN) participants reported the most pain (11.1%) and Asians reported the least pain (2.4%).

In models for predicting pain using survey year, age, sex, and residence location, multiracial and AIAN individuals were found to have the highest prevalence of pain across all categories. The Asian population was consistently found to have the lowest pain rates.

In all comparisons, education, family income, and home ownership were independent and significant predictors for pain.

In the fully adjusted model, multiracial individuals had significantly higher rates of high-impact pain (prevalence ratio [PR], 1.43; P <.001), widespread pain (PR, 1.34; P <.001), any pain (PR, 1.08; P <.001), severe pain (PR, 1.25; P <.05), and 6-month persistent pain (PR, 1.15; P <.05).

Stratified by sex, women reported higher pain than men in the majority of comparison. Women from all racial or ethnic categories reported 1.3- to 1.9-times higher prevalence in pain. The greatest disparity was observed for severe pain, in which 2.2% of Asian men reported pain compared with 12.9% of AIAN women.

Stratified by age, pain was more prevalent among older than younger individuals. Compared with Asian participants, who exhibited a relatively positive linear relationship between age and pain, multiracial and AIAN individuals had a larger increase in pain prevalence during their younger years.

This study was limited by the ambiguity of the multiracial category in the survey, in which participants were not given the opportunity to describe their racial and ethnic heritage.

The study authors concluded, “The biopsychosocial model of pain predicts that people marginalized by social conditions would experience more pain. Our foundational results show more nuanced patterns, in which some minoritized groups show higher pain prevalence than [White individuals], whereas others show lower prevalence. We hope these findings motivate further in-depth studies of drivers of racial/ethnic differences in pain risk, to inform policy, prevention, and intervention efforts.”


Zajacova A, Grol-Prokopczyk H, Fillingim R. Beyond Black vs White: racial/ethnic disparities in chronic pain including Hispanic, Asian, Native American, and multiracial US adults. Pain. Published online January 19, 2022. doi:10.1097/j.pain.0000000000002574