The impact of stressful life events on centralized pain and pain intensity: A combined model examining the mediating roles of anger and perceived injustice among racially minoritized adults with chronic pain.

ABSTRACT

Stressful life events are highly associated with chronic pain. Yet, research is needed to identify the psychological mechanisms that link life adversity and pain, especially studies that test comprehensive models, recruit racially diverse samples, and measure varied pain-related symptoms. This study examined the relationship between stressful life events and pain in a racially diverse sample and tested the potential mediating roles of both anger and perceived injustice. Both centralized pain symptoms and pain intensity were outcomes. Analyses consisted of two cross-sectional, mediation models among 673 adults with self-reported chronic pain who were racially diverse (Black n = 258; Latine n = 254; Asian American n = 161). Results indicated a positive relationship between stressful life events and centralized pain symptoms (b = 2.53, p <.001) and pain intensity (b = 0.20, p <.001). In parallel mediation analyses, anger (b = 0.91, 95% CI = 0.67, 1.17) and perceived injustice (b = 0.86, 95% CI = 0.64, 1.11) acted as partial mediators on centralized pain symptoms. Also, anger (b = 0.05, 95% CI = 0.03, 0.08) and perceived injustice (b = 0.11, 95% CI = 0.08, 0.14) acted as full mediators on pain intensity. The combined psychosocial variables accounted for 51% of centralized pain symptoms and 26% of pain intensity. Findings suggest that psychosocial factors are significantly associated to pain outcomes. Future research is needed to investigate exposure to adversity in life, anger, and perceived injustice together as psychosocial mechanisms of pain symptoms. PERSPECTIVE Among racially minoritized adults with chronic pain, this article presents empirical evidence that stressful life events, anger, and perceived injustice are associated with centralized pain symptoms and pain intensity. This could guide psychological intervention to focus on anger and perceived injustice especially when addressing centralized pain.