Neighborhood disadvantage and pain-related experiences in a pain psychology clinic: The mediating roles of pain catastrophizing and pain-related fear.

This study investigated the relationship between neighborhood disadvantage, measured by the Area Deprivation Index (ADI), and pain-related variables in a pain psychology clinic. We also examined the sequential mediating roles of pain catastrophizing and pain-related fear on these relationships. Participants (N = 509) completed questionnaires assessing usual pain intensity, fatigue, emotional distress, and interference with daily activities. The mean ADI score was 32.57 (SD = 22.65), with scores ranging from 1 to 100. Linear regression analysis, adjusting for age and gender, revealed that higher ADI (i.e., less advantage) was significantly associated with higher scores on pain-related variables (pain intensity: B = 0.026, p < .001; fatigue: B = 0.018, p < .001; emotional distress: B = 0.020, p < .001; interference with daily activities: B = 0.014, p = .006). Sequential mediation analysis revealed pain catastrophizing and pain-related fear mediated these relationships, with significant indirect effects for fatigue (B = 0.001, 95% CI [0.000, 0.002]) and interference with daily activities (B = 0.001, 95% CI [0.001, 0.003]) - but not pain intensity or emotional distress. Pain catastrophizing alone mediated neighborhood disadvantage-pain relationship for all variables. The results suggest that neighborhood disadvantage is associated with higher scores on pain-related experiences and that consistent with the fear avoidance model, pain catastrophizing and pain-related fear may play a role in these relationships for fatigue and interference with daily activities. These findings underscore that neighborhood disadvantage is associated with worse pain-related experiences and highlight the importance of considering neighborhood factors in chronic pain management. PERSPECTIVE: This study identifies potential pathways linking neighborhood disadvantage to chronic pain variables, highlighting the roles of pain catastrophizing and pain-related fear. The findings underscore the need for a holistic approach to pain management that recognizes both individual cognitive-emotional factors and the broader social context in which pain occurs.