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Intersectional pain disparities and resilience in veterans with chronic pain
Journal article   Peer reviewed

Intersectional pain disparities and resilience in veterans with chronic pain

Mackenzie L Shanahan, Bridget Zimmerman, Merlyn Rodrigues, David Green, Jennie Embree, Joseph Buckwalter, Lauren Garvin, Katherine Hadlandsmyth, Tracey Smith, Barbara Rakel, …
Health psychology, Vol.45(1), pp.123-135
01/2026
DOI: 10.1037/hea0001555
PMCID: PMC12707575
PMID: 41396638
url
https://doi.org/10.1037/hea0001555View
Published (Version of record) Open Access

Abstract

Although racial and ethnic pain disparities are well-documented, fewer studies have examined rural and socioeconomic disparities or investigated how identities might intersect to predict pain outcomes. Moreover, little research has explored the protective role resilience may play in mitigating disparities. Guided by Booker's Hierarchy of Health Disparities Research framework, this study aimed to (a) investigate intersectional racial, ethnic, rural, and socioeconomic pain disparities and (b) examine the role of resilience in reducing pain disparities. We sampled a diverse group of 498 Veterans with osteoarthritis who were scheduled for total knee arthroplasty and were enrolled in a randomized controlled trial. Participants completed a battery of validated instruments to assess demographics, pain outcomes, and resilience (pain acceptance, values-aligned behaviors). Participants were primarily older adult males from diverse backgrounds (25% Black; 8% Hispanic; 26% rural; 70% >50th national percentile for socioeconomic disadvantage). Only race was significantly associated with pain outcomes across intersectional groups. There was no evidence of rural pain disparities. Socioeconomic status moderated the relationship between race, physical functioning, and psychological distress, such that racial disparities decreased as socioeconomic disadvantage increased. No other significant socioeconomic disparities emerged. Resilience did not moderate the relationship between race and pain. Rather, resilience was associated with better pain outcomes across racial groups. Findings highlight the robust connection between race and pain. They also suggest that socioeconomic and rural and pain disparities may be less prevalent in Veterans. Resilience may be a modifiable factor that can improve pain outcomes in Black patients. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
 Aged Chronic Pain - ethnology Chronic Pain - psychology Ethnicity - psychology Ethnicity - statistics & numerical data Female Health Status Disparities Humans Male Middle Aged Racial Groups - psychology Racial Groups - statistics & numerical data Resilience, Psychological Rural Population - statistics & numerical data Socioeconomic Factors Veterans - psychology Veterans - statistics & numerical data

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