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Everyday Discrimination in Adults with Knee Pain: The Role of Perceived Stress and Pain Catastrophizing

Authors Terry EL, Fullwood MD, Booker SQ, Cardoso JS, Sibille KT, Glover TL, Thompson KA, Addison AS, Goodin BR, Staud R, Hughes LB, Bradley LA, Redden DT, Bartley EJ, Fillingim RB

Received 22 October 2019

Accepted for publication 3 April 2020

Published 1 May 2020 Volume 2020:13 Pages 883—895


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr E Alfonso Romero-Sandoval

Ellen L Terry,1 M Dottington Fullwood,2 Staja Q Booker,1 Josue S Cardoso,3 Kimberly T Sibille,2 Toni L Glover,4 Kathryn A Thompson,5 Adriana S Addison,6 Burel R Goodin,5 Roland Staud,7 Laura B Hughes,6 Laurence A Bradley,6 David T Redden,8 Emily J Bartley,9 Roger B Fillingim3,9

1Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, United States; 2Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, United States; 3Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida, United States; 4Oakland University, School of Nursing, Rochester, MI, United States; 5Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States; 6University of Alabama at Birmingham, Division of Clinical Immunology & Rheumatology, Birmingham, Alabama, United States; 7Department of Medicine, University of Florida, Gainesville, Florida, United States; 8Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States; 9University of Florida, Community Dentistry and Behavioral Science, Gainesville, Florida, United States

Correspondence: Ellen L Terry
Department of Biobehavioral Nursing Science, University of Florida, PO Box 100197, Gainesville FL 32610-0197 Tel ( +352) 273-6441

Purpose: Research indicates pain-related disparities in the impact of knee osteoarthritis (OA) across both sex and ethnicity/race. While several factors likely contribute to these disparities, experiences of discrimination are associated with poor OA-related pain, disability, and functional performance. However, the mechanisms that mediate experiences of discrimination and OA-related outcomes are unclear. The current cross-sectional study examined the associations between everyday experiences of discrimination and clinical pain, disability and functional performance among non-Hispanic Black (NHB) and non-Hispanic White (NHW) persons with or at risk of knee OA and assessed the serial mediated model of perceived stress and pain catastrophizing on these relationships in women only.
Patients and Methods: Participants were 188 community-dwelling adults who presented with unilateral or bilateral knee pain and screened positive for clinical knee pain. Participants completed several measures including experiences of discrimination, Perceived Stress Scale, Coping Strategies Questionnaire-Revised (CSQ-R): Pain Catastrophizing subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Graded Chronic Pain Scale (GCPS), and Short Physical Performance Battery (SPPB).
Results: As compared to NHW participants, NHB individuals reported experiencing significantly higher levels of discrimination (F(1, 175)=26.660, p< 0.001), greater levels of pain catastrophizing (F(1, 180)=12.919, p< 0.001), higher levels of clinical pain and disability, and lower levels of physical function (ps< 0.05). However, perceived stress was positively correlated with discrimination in the NHW group only (NHW females: r=0.40, p< 0.01; NHW males: r=0.37, p< 0.05). Further, perceived stress and pain catastrophizing mediated the relationship between discrimination and outcome variables (WOMAC pain, GCPS interference [pain disability], and SPPB function) in female participants after controlling for relevant sociodemographic variables (study site, age, race, income, and body mass index).
Conclusion: These results may have implications for the treatment of perceived stress and catastrophizing as a means to reduce the negative impact of experiences of discrimination on the experience of chronic pain, particularly for women.

Keywords: experiences of discrimination, Perceived Stress Scale, pain catastrophizing, knee osteoarthritis, pain, disability, physical function

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