Kim Shin Ye, Nguyen Nguyen P, Shigemoto Yuki
Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA.
Department of Educational Psychology, Texas A &M University, College Station, TX, USA.
Health Psychol Behav Med. 2025 Jan 26;13(1):2454701. doi: 10.1080/21642850.2025.2454701. eCollection 2025.
Despite mounting evidence of a robust relation between discrimination and poor pain outcomes in people of color (POC) with chronic pain, little is known about everyday discrimination's role in increasing the risk of opioid misuse and its potential interactive effects. This study aimed to evaluate the potential moderating effect of everyday discrimination on the relationship between chronic pain severity and the risk of opioid misuse among POC with chronic pain. Everyday discrimination was assessed using the 9-item Everyday Discrimination Scale (EDS), while the risk of opioid misuse was measured with the 14-item Screener and Opioid Assessment for Patients with Pain (SOAPP). Using a racially diverse sample of 348 individuals with chronic pain, ranging in age from 20 to 75 years old (M = 28.56), this study investigated these relationships through path analysis conducted in Mplus, controlling for age, sex, and social class. The results showed that high levels of everyday discrimination placed POC patients at a higher risk of opioid misuse when they experienced more severe pain. When chronic physical pain was accompanied by chronic social pain stemming from discrimination, POC patients reported a significantly higher risk of opioid misuse. Discrimination may intensify pain severity, potentially necessitating a higher dose and/or longer-term opioid treatment and, thus, increasing the risk of opioid misuse among POC. The integration of routine assessments of patients' experiences of discrimination could strengthen the ecological validity of pain assessment and treatment. Where feasible, clinicians might consider exploring the experiences of discrimination among POC patients as part of a holistic approach to pain management, and when indicated, facilitate referrals to psychosocial services to address both social and physical aspects of pain.
尽管越来越多的证据表明，慢性疼痛的有色人种（POC）中，歧视与不良疼痛结局之间存在密切关系，但对于日常歧视在增加阿片类药物滥用风险方面的作用及其潜在的交互作用，人们知之甚少。本研究旨在评估日常歧视对慢性疼痛的POC中慢性疼痛严重程度与阿片类药物滥用风险之间关系的潜在调节作用。使用9项日常歧视量表（EDS）评估日常歧视，而使用14项疼痛患者筛查和阿片类药物评估量表（SOAPP）测量阿片类药物滥用风险。本研究采用了一个种族多样化的样本，包括348名年龄在20至75岁之间（M = 28.56）的慢性疼痛患者，通过在Mplus中进行路径分析来研究这些关系，同时控制年龄、性别和社会阶层。结果表明，当POC患者经历更严重的疼痛时，高水平的日常歧视会使他们面临更高的阿片类药物滥用风险。当慢性身体疼痛伴有因歧视产生的慢性社会疼痛时，POC患者报告的阿片类药物滥用风险显著更高。歧视可能会加剧疼痛严重程度，可能需要更高剂量和/或更长时间的阿片类药物治疗，从而增加POC中阿片类药物滥用的风险。将对患者歧视经历的常规评估纳入其中，可以增强疼痛评估和治疗的生态效度。在可行的情况下，临床医生可能会考虑将探索POC患者的歧视经历作为疼痛管理整体方法的一部分，并且在有指征时，促进转介至心理社会服务机构，以解决疼痛的社会和身体方面问题。
