Pain and Physical Function in a Socioeconomically Diverse Sample of Black and White Adults

Musculoskeletal pain alters physiological function and these changes may be evidenced as early as middle age. Previous research has concluded that middle-aged adults are a high-risk group for chronic pain and report functional limitations similar to older adults. However, few studies have explored the unique individual factors (e.g., sociodemographic, health, and psychosocial characteristics) that may drive the pain experience; and more research is needed that examines the relationships between musculoskeletal pain and physical function, using objective performance measures, in a sample of racially and socioeconomically diverse adults. Data from the Healthy Aging in Neighborhoods of Diversity across the Life Span Study (HANDLS) were analyzed across two cross-sectional studies. The first study examined the association between subjective (self-reported) and objective measures of pain (passive range of motion) of the hands, neck and low back. Additionally, this study explored the unique predictors that may be associated with inconsistency between subjective and objective measurements of pain. Results indicated weak but significant correlations between subjective and objective hand- pain measurements. However, there were no significant correlations identified between subjective and objective neck-pain measurements, or subjective and objective low back pain measurements. Three binary logistic regression models were conducted to explore the relationship between sociodemographic (Model 1), health (Model 2), and psychosocial characteristics (Model 3) of consistent and inconsistent pain measurements for each pain site. There were no significant relationships between sociodemographic, health, or psychosocial characteristics and consistent and inconsistent hand pain measurements. However, individuals who reported a history of depressive symptoms were nearly 1.8 times more likely to report inconsistent neck pain. Follow-up analyses to explore two-way interactions across unique predictors identified that individuals with a history of depressive symptoms, who were below poverty status, were nearly 3 times more likely to report inconsistent neck pain. Additionally, females, individuals with a greater number of comorbidities, and those with a history of depressive symptoms tended to demonstrate inconsistent low back pain. Follow-up analyses identified that those who identified a history of depressive symptoms, and reported the quality of their neighborhood as “poor” to “fair”, were 3.3 times more likely to demonstrate inconsistent low back pain measurements. The second study examined the relationship between pain, pain interference and a global measure of physical function. Additionally, the study investigated whether relationships between pain, pain interference, and global physical function were moderated by sociodemographic characteristics (e.g., age, sex, race, and measures of socioeconomic status). In multivariable regression analyses, musculoskeletal pain was significantly associated with physical function, particularly among middle-aged and older individuals. Additionally, pain interference was significantly associated with physical function, particularly among older adults. This dissertation strives to further our understanding of the unique factors that contribute to individualized pain experiences among under-represented populations, and to identify functional deficits that may be evidenced earlier in the life course. Furthermore, this dissertation is intended to motivate further research that explores appropriately timed non-pharmacological interventions that are tailored to the needs of diverse groups, in efforts to reduce musculoskeletal pain, pain interference, and sustain functional independence in later life