Pain phenotype trajectories and links to family relationship quality among black older adults

Given persistent pain disparities experienced by older Black adults, understanding associations between family relationships and how chronic pain unfolds during aging has important clinical implications. This study aims to identify distinct longitudinal pain phenotype trajectories and whether these are associated with family relationship quality among older Black Americans. We included Black participants (N=2586; 64% women; mean age=66.65) from eight biennial waves (2006–2020) of the nationally representative Health and Retirement Study who reported on pain incidence at baseline. Latent class analyses (LCA) of pain incidence, severity, interference, and prescription pain medication use identified three cross-sectional pain phenotypes, consistently, at each wave: no pain; mild-to-moderate chronic pain; and severe high-impact chronic pain. Second-order LCA determined each participant’s probability of experiencing each pain phenotype at each wave, simultaneously, and identified five 14-year pain phenotype trajectories: No Chronic Pain; Persistent Mild-to-Moderate Chronic Pain; Persistent Severe High-Impact Chronic Pain; Chronic Pain Recovery; Chronic Pain Worsening. Compared to pain-free adults, the odds of persistent mild-to-moderate pain were lower with greater intimate partner support and higher with greater intimate partner strain. The odds of persistent severe high-impact chronic pain were lower with greater intimate partner, family, and parent-child support, each, and higher with greater family and parent-child strain. Greater parent-child strain was also linked to higher odds of pain worsening over time. Ameliorating strained relationships and leveraging supportive relationship benefits may provide a culturally-attuned biopsychosocial approach to improving older Black Americans’ pain. Research is needed to determine mediating mechanisms for identification of precise intervention targets.

Perspective

This article describes trajectories of pain phenotypes (clusters of distinct pain indicators) for older Black Americans. Identified links between supportive and strained family relationships and ways in which aging Black adults’ pain unfolds over time may provide apt intervention targets in biopsychosocial pain management approaches.