Visiting Black Patients: Racial Disparities in Security Standby Requests.

BACKGROUND: Structural inequalities exist within healthcare. Racial disparities in hospital security standby requests (SSRs) have not been previously explored. We speculated hospital SSRs varied based upon race with black patients and their visitors negatively impacted. METHODS: An 8-year retrospective study of hospital security dispatch information was performed. Data were analyzed to determine demographic information, and service location patterns for SSRs involving patients and their visitors. The race of the patient's visitors was imputed using the patient's race. The observed and expected (using hospital census data) number of patients impacted by SSRs was compared. Descriptive statistics were computed. Categorical data were analyzed using chi-square or Fisher exact test statistic. A p < 0.05 was statistically significant. RESULTS: The majority of the 1023 SSRs occurred for visitors of patients who were white (N = 642; 63%), female (56%), or < 21 years old (50.7%). However, SSRs differed significantly based upon the patient's race. Although Black patients represent 12% of the hospital population, they and their visitors were more than twice as likely (p < 0.0001) to have a SSR generated (N = 275; 27%) when compared to the visitors of both White and other (i.e., race unknown) patients (N = 106; 10%) combined (p < 0.0001). CONCLUSION: This study adds to the medical errors and healthcare disparities literature by being the first to describe racial disparities in SSRs for Black patients and their visitors. It also introduces the concept of "security intervention errors in healthcare environments." New metrics and continuous quality improvement initiatives are needed to understand and eliminate racial/ethnic based disparities in SSRs.

Chronic Back Pain Is Associated with Alterations in Dopamine Neurotransmission in the Ventral Striatum.

Back pain is common in the general population, but only a subgroup of back pain patients develops a disabling chronic pain state. The reasons for this are incompletely understood, but recent evidence implies that both preexisting and pain-related variations in the structure and function of the nervous system may contribute significantly to the development of chronic pain. Here, we addressed the role of striatal dopamine (DA) D2/D3 receptor (D2/D3R) function in chronic non-neuropathic back pain (CNBP) by comparing CNBP patients and healthy controls using PET and the D2/D3R-selective radioligand [(11)C]raclopride. D2/D3R availability was measured at baseline and during a pain challenge, yielding in vivo measures of receptor availability (binding potential, BPND) and DA release (change in BPND from baseline to activated state). At baseline, CNBP patients demonstrated reductions in D2/D3R BPND in the ventral striatum compared with controls. These reductions were associated with greater positive affect scores and pain tolerance measures. The reductions in D2/D3R BPND were also correlated with µ-opioid receptor BPND and pain-induced endogenous opioid system activation in the amygdala, further associated with measures of positive affect, the affective component of back pain and pain tolerance. During the pain challenge, lower magnitudes of DA release, and therefore D2/D3R activation, were also found in the ventral striatum in the CNBP sample compared with controls. Our results show that CNBP is associated with adaptations in ventral striatal D2/D3R function, which, together with endogenous opioid system function, contribute to the sensory and affective-motivational features of CNBP. SIGNIFICANCE STATEMENT: The neural systems that underlie chronic pain remain poorly understood. Here, using PET, we provide insight into the molecular mechanisms that regulate sensory and affective dimensions of pain in chronic back pain patients. We found that patients with back pain have alterations in brain dopamine function that are associated with measures of pain sensitivity and affective state, but also with brain endogenous opioid system functional measures. These findings suggest that brain dopamine-opioid interactions are involved in the pathophysiology of chronic pain, which has potential therapeutic implications. Our results may also help to explain individual variation in susceptibility to opioid medication misuse and eventual addiction in the context of chronic pain.

National Institutes of Health Pathways to Prevention Workshop: Advancing the Research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

The National Institutes of Health (NIH) Pathways to Prevention Workshop: Advancing the Research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome was cosponsored by the NIH Office of Disease Prevention and the Trans-NIH Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Research Working Group. A multidisciplinary working group developed the agenda, and an Evidence-based Practice Center prepared an evidence report through a contract with the Agency for Healthcare Research and Quality to facilitate the discussion. During the 1.5-day workshop, invited experts discussed the body of evidence and attendees had the opportunity to comment during open discussions. After weighing evidence from the evidence report, expert presentations, and public comments, an unbiased, independent panel prepared a draft report that identified research gaps and future research priorities. The report was posted on the NIH Office of Disease Prevention Web site for 4 weeks for public comment.

Pathways to Advancing Aging Policy-Relevant Research in Academic Settings.

Policy-level changes have a significant influence on the health and well-being of aging populations. Yet there is often a gap between scientific knowledge and policy action. Although previous research has identified barriers and facilitators to effective knowledge translation, little attention has been given to the role of academic institutions in knowledge generation. This exploratory focus group study examines barriers and pathways to developing and maintaining an aging policy-relevant research agenda in academic settings, and additional challenges associated with minority group membership in this pursuit. Participants were personally committed to conducting policy-relevant research despite institutional barriers such as fewer funding opportunities and less value attributed to their research, particularly in the context of tenure and promotion. Although many viewed their research as an opportunity to make a difference, especially for underserved older adult populations, a number of minority group participants expressed that their policy research interests were marginalized. Participants offer individual and institutional-level strategies for addressing barriers, including collaborating with community members and colleagues and engaging mentors within and outside of their academic institutions. Reframing the valuation of policy research through the diversification of funding and publishing opportunities can better support scholars engaged in aging policy-relevant research.

Alterations in endogenous opioid functional measures in chronic back pain.

The absence of consistent end organ abnormalities in many chronic pain syndromes has led to a search for maladaptive CNS mechanisms that may explain their clinical presentations and course. Here, we addressed the role of brain regional µ-opioid receptor-mediated neurotransmission, one of the best recognized mechanisms of pain regulation, in chronic back pain in human subjects. We compared µ-opioid receptor availability in vivo at baseline, during pain expectation, and with moderate levels of sustained pain in 16 patients with chronic nonspecific back pain (CNBP) and in 16 age- and gender-matched healthy control subjects, using the µ-opioid receptor-selective radioligand [(11)C]carfentanil and positron emission tomography. We found that CNBP patients showed baseline increases in thalamic µ-opioid receptor availability, contrary to a previously studied sample of patients diagnosed with fibromyalgia. During both pain expectation and sustained pain challenges, CNBP patients showed regional reductions in the capacity to activate this neurotransmitter system compared with their control sample, further associated with clinical pain and affective state ratings. Our results demonstrate heterogeneity in endogenous opioid system functional measures across pain conditions, and alterations in both receptor availability and endogenous opioid function in CNBP that are relevant to the clinical presentation of these patients and the effects of opioid analgesics on µ-opioid receptors.

The impact of sexual or physical abuse history on pain-related outcomes among blacks and whites with chronic pain: gender influence.

OBJECTIVES: Physical and sexual abuses commonly co-occur with chronic pain. We hypothesized that: 1) abuse history questions would form distinct factors that relate differently to pain perceptions and pain outcomes; 2) abuse history consequences on physical and mental health differ by gender; and 3) different abuse types and age of occurrence (childhood vs adolescent/adulthood) predict different negative outcomes. METHODS: Chronic pain patients at a tertiary care pain center provided data (64% women, 50% black) through a confidential survey. Factors were formed for abuse type and age. Linear regression, controlling for socio-demographic information, was used to examine the relationship between abuse and abuse by sex interactions with pain-related outcomes. RESULTS: Six 3-item abuse factors (α = 0.77-0.91)-sexual molestation, sexual penetration, and physical abuse-were identified in both childhood and adulthood. Lifetime prevalence of abuse was 70% for men and 65% for women. Women experienced lower physical abuse (P = 0.01) in childhood, and higher penetration (P = 0.02) in adulthood. Decreased general health was associated with all abuse types (P < 0.05) in childhood. Affective pain was associated with all childhood abuse scales and adulthood molestation, though childhood molestation only for men (P = 0.04). Disability was associated with childhood (P = 0.02) and adulthood rape (P = 0.04). Men with childhood or adulthood molestation (P = 0.02; P = 0.02) reported higher post-traumatic stress disorder. CONCLUSIONS: Our study confirms physical and mental health, and pain-related outcomes are affected by abuse history for men and women. These results support screening all patients for abuse to improve the survivor's overall health and well-being.

Cancer pain: an age-based analysis.

OBJECTIVE: Although cancer pain (consistent and breakthrough pain [BTP; pain flares interrupting well-controlled baseline pain]) is common among cancer patients, its characteristics, etiology, and impact on health-related quality of life (HRQOL) across the lifespan are poorly understood. DESIGN: This longitudinal study examines age-based differences and pain-related interference in young and old patients with cancer-related pain over 6 months. Patients in the community with stage III or IV breast, prostate, colorectal, or lung cancer, or stage II-IV multiple myeloma with BTP completed surveys (upon initial assessment, 3 and 6 months) assessing consistent pain, BTP, depressed affect, active coping ability, and HRQOL using previously validated measures. RESULTS: Respondents (N= 96) were 70% white and 66% female, with a mean age of 57±10 years. There were no significant differences in pain severity based upon age. However, the younger group experienced more pain flares with greater frequency (P=0.05). The oldest group had better emotional functioning at baseline but worse physical functioning at 6 months. Younger groups also had worse cognitive functioning at 6 months (P=0.03). Pain interference was independent of age. CONCLUSIONS: These data provide evidence for the significant toll of cancer pain on overall health and well-being of young and old adults alike but demonstrate an increased toll for younger adults (especially financially). Beyond race and gender disparities, further health care disparities in the cancer and cancer pain were identified by age, illustrating the need for additional research across the lifespan in diverse cancer survivors.

Predictors of complementary and alternative medicine use in chronic pain patients.

OBJECTIVE: We used Andersen's behavioral model of healthcare utilization to assess the relationship between sociodemographic, physical and psychosocial factors, and Complementary and Alternative Medicine (CAM) use among chronic pain patients. Three practitioner-based alternative therapies were considered: acupuncture, biofeedback/relaxation training, and manipulation services. DESIGN: A retrospective analysis of self-reported clinical data with 5,750 black and white adults presenting for initial assessment between 1994 and 2000 at the University of Michigan Multidisciplinary Pain Center was performed. RESULTS: CAM therapies were used in high frequencies, with 34.7% users. Specifically 8.3% used acupuncture, 13.0% used biofeedback/relaxation, and 24.9% used manipulation techniques. Race and age were predisposing factors associated with CAM use. Blacks used less biofeedback/relaxation and manipulation services than whites. Aging was related to more acupuncture, but less biofeedback/relaxation use. Women marginally used more biofeedback/relaxation services than men, and education was positively associated with all three CAM use. Perceived pain control was a consistent enabling factor positively correlated with the use of all three CAM services. Among need factors, pain characteristics and physical health were positively associated with at least one of the modalities. Depressive symptoms were not related to CAM services use. CONCLUSION: This study identifies variable patterns of CAM usage based on sociodemographic and health factors in chronic pain patients. Overall, who uses CAM depends on the modality; however, education, pain severity, and pain duration are persistent correlates of CAM usage regardless of the therapy considered. We found that mental health, as measured by depressive symptoms, had no noticeable impact on CAM usage among chronic pain patients. The clinical, policy, and research implications of CAM use are discussed.

Physical and psychosocial health in older women with chronic pain: comparing clusters of clinical and nonclinical samples.

BACKGROUND: This investigation examined why some elderly women with severe pain symptoms and impairment in health status were not seen in a tertiary care pain center. METHODS: Three groups of older (> or = 60 years) women were included in the study: women seeking chronic pain treatment at a multidisciplinary pain center (N = 49), and research volunteers from the same institution with (N = 28) and without (N = 27) chronic pain. A clustering classification technique was used to identify clusters of older women with similar physical and mental health status. RESULTS: We found three clusters: 1) a healthy cluster (cluster 1: mostly nonclinical women); 2) a cluster with very poor physical and mental health status (cluster 3); and 3) a cluster with low physical health but average mental health (cluster 2). Although only cluster 1 had significantly higher physical health (P < 0.001), all three clusters had different mental health (P < 0.001). Within cluster 2, clinical women had more pain than nonclinical women, but within cluster 3, this was not so, indicating that mental health issues may create an obstacle to women having their pain appropriately assessed and treated. CONCLUSIONS: Our findings support that while disability and pain severity contribute to specialized pain services usage among older women, there is a subgroup of people not receiving pain care for whom these pain symptoms are similar. Further studies are needed to assess the role of health-seeking behavior, coping preferences, referral patterns, and patient-physician communication on access to tertiary pain care for older women.

The impact of chronic pain on the health of black and white men.

Persistent pain, disability, and depression are hallmarks for chronic pain. While disparities based upon race, gender, and class are documented, little is known about pain disparities in minority men. This investigation examines black (6.2%) and white (93.8%) men (N = 1650) presenting for initial assessment at a tertiary care pain center. Racial comparisons utilized analysis of variance; all variables of interest were then placed in a theoretical model using path analysis. The model included race, age, education, neighborhood income, marital status, litigation, substance use, and high blood pressure as predictors and pain, depression, affective distress, posttraumatic stress disorder (PTSD), and disability as outcomes. Black race was associated with lower neighborhood income, education and marriage rates, and higher rates of litigation and high blood pressure. Black men also had higher pain (affective and miscellaneous), disability, and depression. Path analysis found black race was a direct predictor of greater pain, and through pain, was an indirect predictor of depression, affective distress, PTSD, and disability. Path analysis confirmed the complexity of relationships and supported using techniques to understand these relationships. Our data highlight disparities in the pain experience for black men. They also elucidate potential mechanisms through which disparities work in vulnerable and understudied populations.

Cancer and breakthrough pain's impact on a diverse population.

BACKGROUND: Although breakthrough pain (BTP; pain flares interrupting well-controlled baseline pain) is common among patients with cancer, its prevalence, characteristics, and impact on health-related quality of life (HRQOL) are poorly understood in ethnic minorities. METHODS: This comparative study examines ethnic and gender differences in BTP characteristics and impact on HRQOL. Patients with stage III or IV cancer of the breast, prostate, colorectal, or lung, or stage II-IV multiple myeloma with BTP completed surveys (upon initial assessment, 3 months, and 6 months) assessing consistent pain, BTP, depressed affect, active coping ability, and HRQOL. RESULTS: Respondents (N = 96) were 75% white, 66% female with a mean age of 56 +/- 10 years. All subjects experienced significant psychological distress, but there were no racial differences in depression prevalence. Minorities reported significantly greater severity for consistent pain at its worst (P = 0.009), least (P < or = 0.001), on average (P = 0.004), and upon initial assessment (P = 0.04) as well as greater severity for BTP at its worst (P = 0.03), least (P = 0.02), and at initial assessment (P = 0.008). Although minorities reported more flare types (3.0 vs 1.8, P = 0.001), there were no significant ethnic differences in the duration, quality, or location of pain flares. Minorities consistently reported poorer outcomes on each HRQOL subscale (physical, role, emotional, cognitive, and social functioning) measured, although not statistically significant, as well as poorer QOL symptom control (P = 0.08) including lower dyspnea control (P = 0.002). CONCLUSIONS: Overall, minorities experienced greater consistent and breakthrough pain as well as poorer HRQOL. These data suggest further health care disparities in the cancer and pain experience for minorities.

The association among neighborhood socioeconomic status, race and chronic pain in black and white older adults.

The association among race, neighborhood socioeconomic status (SES), and chronic pain has not been well examined in older people. Clinical data was obtained from older adults (>50 years old) presenting to a tertiary care pain center. The relative roles of race and neighborhood SES on the chronic pain experienced in older black and white adults were assessed. Older blacks experienced more affective pain, pain-related disability and mood disorder symptoms than older whites. Confirmatory factor analysis confirmed previously hypothesized factors for the McGill Pain Questionnaire pain dimensions and the Pain Disability Index. Exploratory and confirmatory factor analyses also identified factors in the Brief Symptom Inventory and neighborhood SES. Structural equation modeling showed black race was associated with lower neighborhood SES and also with increased affective pain, obligatory disability and mood disorders mediationally through neighborhood SES. It was indirectly associated with increased sensory and miscellaneous pain, and voluntary disability through low neighborhood SES. Racial interaction examination showed that neighborhood SES had the same relationship to outcomes by race. We found increasing neighborhood SES is associated with decreasing negative chronic pain outcomes for older blacks and whites. Our data provide evidence that both race and neighborhood SES are important factors to consider when examining the chronic pain experience among older Americans.

Promoting Retention: African American Older Adults in a Research Volunteer Registry.

Objectives: The objectives of this study were to evaluate the capability of a research volunteer registry to retain community-dwelling African American older adults, and to explore demographic and health factors associated with retention. Method: A logistic regression model was used to determine the influence of demographics, health factors, and registry logic model activities on retention in a sample of 1,730 older African American adults. Results: Almost 80% of participants active in the volunteer research registry between January 2012 and June 2015 were retained. Employment, being referred to research studies, a higher number of medical conditions, and more follow-up contacts were associated with an increased likelihood of retention. Older age, more months in the registry, and more mobility problems decreased the likelihood of retention. Discussion: These results suggest the Michigan Center for Urban African American Aging Research logic model promotes retention through involving older African American adults in research through study referrals and intensive follow-up. The loss of participants due to age- and mobility-related issues indicate the registry may be losing its most vulnerable participants.

Differences in prescription opioid analgesic availability: comparing minority and white pharmacies across Michigan.

UNLABELLED: Little is known about physical barriers to adequate pain treatment for minorities. This investigation explored sociodemographic determinants of pain medication availability in Michigan pharmacies. A cross-sectional survey-based study with census data and data provided by Michigan community retail pharmacists was designed. Sufficient opioid analgesic supplies was defined as stocking at least one long-acting, short-acting, and combination opioid analgesic. Pharmacies located in minority (or=70% white residents) zip code areas were randomly selected by using a 2-stage sampling selection process (response rate, 80%). For the 190 pharmacies surveyed, most were located in white areas (51.6%) and had sufficient supplies (84.1%). After accounting for zip code median age and stratifying by income, pharmacies in white areas (odds ratio, 13.36 high income vs 54.42 low income) and noncorporate pharmacies (odds ratio, 24.92 high income vs 3.61 low income) were more likely to have sufficient opioid analgesic supplies (P < .005). Racial differences in the odds of having a sufficient supply were significantly higher in low income areas when compared with high income areas. Having a pharmacy located near a hospital did not change the availability for opioid analgesics. Persons living in predominantly minority areas experienced significant barriers to accessing pain medication, with greater disparities in low income areas regardless of ethnic composition. Differences were also found on the basis of pharmacy type, suggesting variability in pharmacist's decision making. PERSPECTIVE: Michigan pharmacies in minority zip codes were 52 times less likely to carry sufficient opioid analgesics than pharmacies in white zip codes regardless of income. Lower income areas and corporate pharmacies were less likely to carry sufficient opioid analgesics. This study illustrates barriers to pain care and has public health implications.

Racial differences in the physical and psychosocial health among black and white women with chronic pain.

Gender-based differences in pain epidemiology, pain threshold, attitudes toward pain management, coping styles and social roles are well described, yet little is known about the chronic pain experience in women or the role race plays. A retrospective analysis of self-reported data using a secondary clinical database was performed to elucidate the relationship between race and pain severity, depression, physical disability, posttraumatic stress disorder (PTSD) as well as affective distress in women with chronic pain. White (n=1,088) and black (n=104) adult women were compared based on their responses to the McGill Pain Questionnaire, Beck Depression Inventory, Pain Disability Index, Posttraumatic Chronic Pain Test and items from the West-Haven Yale Multidisciplinary Pain Inventory. After accounting for sociodemographic, medical, psychological and physical confounders, there was no significant race effect for pain severity or affective distress. However, black women with chronic pain experience more physical impairments than white women with chronic pain (beta = 4.622; p<0.005). Except for the family/home responsibilities, similar differences were found on all PDI subscales. We also found that disability mediates the race-depression relationship such that black women are comparatively more vulnerable to depression as a result of higher disability. Due to the economic, social and emotional impact that disability has on women with chronic pain and their families, these findings have significant implications for chronic pain research as well as its management in black women.

Clinical decision making in pain management: Contributions of physician and patient characteristics to variations in practice.

Differences in the quality of pain management may very well be due to physician characteristics and their treatment goals based on the type of pain or patient demographics. This study was done to (1) determine the role of physician characteristics in their goals and treatment of acute, cancer, and chronic pain and (2) provide an evaluation of the differences in physician pain management decision making due to patient characteristics and the type of pain being treated. A prospective cohort study of 368 Michigan physicians was done to determine their pain management knowledge, attitudes, and prescribing habits via study-specific multi-item mail survey. Nine clinical vignettes were used to examine potential differences in the physician's pain management based on the type of pain and patient demographic characteristics. The responses of the study group varied on the basis of the type of pain and gender of the patient. They were more likely to provide optimal treatment for men with acute postoperative or cancer pain. The physicians also reported lesser goals for relief of chronic pain when compared to acute and cancer pain. Lower goals for chronic pain relief may lead to the undertreatment of chronic pain. This study demonstrates that the provision of adequate pain management may be influenced by patient characteristics and physician variability.

Race, age, and gender influences among clusters of African American and white patients with chronic pain.

UNLABELLED: Racial and ethnic minorities, older people, and women are differentially affected by chronic pain. This study aimed to identify the experiences of adult African Americans and whites with chronic pain while identifying patient clusters on the basis of clinical characteristics as well as race, age, and gender influences within and between clusters. Three clusters of patients with chronic pain were identified within race, age, and gender categories: chronic pain syndrome, good pain control, and disability with mild syndrome. African American and younger patients experiencing chronic pain were more likely to present with chronic pain syndrome. African American patients presenting with chronic pain syndrome or disability with mild pain syndrome reported a higher disability than their counterparts. Older patients and women within the good pain control cluster reported a lower level of (1) pain and depression and (2) depression, respectively. Older patients presenting with a disability with mild syndrome also reported lower pain and depression. Despite similar physical, emotional, and pain characteristics, this study confirmed that the chronic pain experience differs across racial and age groups. Further study is necessary to evaluate how these factors influence pain services among an ethnically diverse population across the age continuum. PERSPECTIVE: This study found important racial and age-related variability in the symptom severity of patients with chronic pain presenting with similar physical, emotional, and pain characteristics to a tertiary care pain center. These findings have important clinical implications on chronic pain assessment and management.

Patient attitudes regarding healthcare utilization and referral: a descriptive comparison in African- and Caucasian Americans with chronic pain.

The purpose of this study was to evaluate healthcare utilization and referral patterns for pain management services in a racially and ethnically diverse population. A study-specific mail survey was directed at African- (N=324) and Caucasian Americans (N=300) receiving chronic pain treatment at a tertiary care pain center to address their healthcare access, referral, and utilization patterns. Overall, 46% (N=286) responded, with the majority of respondents being Caucasian Americans (57%) and women (68%). The majority (58%) reported asking their physicians to refer them to a pain physician. African Americans were more likely to report that chronic pain was a major reason for financial problems. They made significantly more visits to the emergency room for pain care. African Americans agreed more that ethnicity and culture affected access to healthcare and pain management. They also tended to agree more than Caucasian Americans that pain medication could not control pain. These results demonstrate significant differences in healthcare utilization, access, and attitudes amongst African- and Caucasian Americans receiving chronic pain management. In light of the socioeconomic and health consequences of chronic pain, these results suggest the need for further studies addressing variability in pain care access and utilization in diverse populations.

The role of cryoanalgesia for chronic thoracic pain: results of a long-term follow up.

Cryoanalgesia (the use of cold to provide anesthesia or analgesia) is the oldest anesthetic and analgesic still in current clinical use. Its intraoperative use in providing postoperative analgesia for acute thoracic pain problems via an open thoracotomy is well described. The long-term efficacy of cryoanalgesia for the management of chronic thoracic pain due to intercostal neuralgia is less clear. We retrospectively examined the medical records of patients who received percutaneous cryoanalgesia following successful intercostal nerve blockade for chronic chest pain. Sixty percent of the patients (N = 43) reported significant pain relief immediately following their procedure. Three months following cryoanalgesia, 50% continued to report significant pain relief. There were no reports of neuritis or neuroma formation and only three patients had a pneumothorax. This work provides evidence that cryoanalgesia is a safe and efficacious method of providing analgesia for chronic thoracic pain due to intercostal neuralgia.

The association between race and neighborhood socioeconomic status in younger Black and White adults with chronic pain.

UNLABELLED: Both race and socioeconomic status (SES) contribute to disparities. We assessed the relative roles of neighborhood socioeconomic status (nSES) and race in the chronic pain experience for young adults (<50 years old). Data from a tertiary care pain center was matched to 2000 US Census data to examine the role of race and nSES on chronic pain and its sequelae in 3,730 adults (9.7% black, 61% female) 18 to 49 years old (37 ± 8 years). Blacks had significantly more pain and disability and lived in lower SES neighborhoods. Living in a lower SES neighborhood was associated with increased sensory, affective, and "other" pain, pain-related disability, and mood disorders. Race was independently associated with affective and "other" pain on the McGill Pain Questionnaire scales, and both disability factors. Racial disparities in sensory pain and mood disorders were mediated by nSES. In every case, race and neighborhood SES played important roles in the outcomes for chronic pain. Age was related to both disability outcomes. Gender was associated with voluntary disability and mood disorders, with men displaying worse outcomes. PERSPECTIVE: Important racial- and SES-related variability in pain related outcomes in young adults with chronic pain were defined. Black race was associated with neighborhood SES, and black race plays an important role in pain outcomes beyond neighborhood SES.