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J Pain. 2019 Sep 25. pii: S1526-5900(19)30815-6. doi: 10.1016/j.jpain.2019.09.007. [Epub ahead of print]

Injustice Appraisal, but not Pain Catastrophizing, Mediates the Relationship Between Perceived Ethnic Discrimination and Depression and Disability in Low Back Pain.

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Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California.
Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington. Electronic address:
Department of Family Medicine, John Peter Smith Health Network, Fort Worth, Texas.
Department of Psychology, University of North Texas, Denton, Texas.
Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama.


Despite growing evidence of significant racial disparities in the experience and treatment of chronic pain, the mechanisms by which these disparities manifest have remained relatively understudied. The current study examined the relationship between past experiences of racial discrimination and pain-related outcomes (self-rated disability and depressive symptomatology) and tested the potential mediating roles of pain catastrophizing and perceived injustice related to pain. Analyses consisted of cross-sectional path modeling in a multiracial sample of 137 individuals with chronic low back pain (Hispanics: n = 43; blacks: n = 43; whites: n = 51). Results indicated a positive relationship between prior discriminatory experiences and severity of disability and depressive symptoms. In mediation analyses, pain-related appraisals of injustice, but not pain catastrophizing, were found to mediate these relationships. Notably, the association between discrimination history and perceived injustice was significantly stronger in black and Hispanic participants and was not statistically significant in white participants. The findings suggest that race-based discriminatory experiences may contribute to racial disparities in pain outcomes and highlight the specificity of pain-related, injustice-related appraisals as a mechanism by which these experiences may impair physical and psychosocial function. Future research is needed to investigate temporal and causal mechanisms suggested by the model through longitudinal and clinical intervention studies. PERSPECTIVE: More frequent prior experiences of racial discrimination are associated with greater depressive symptomatology and pain-related disability in individuals with chronic low back pain. These associations are explained by the degree of injustice perception related to pain, but not pain catastrophizing, and were stronger among black and Hispanic participants.


Racial discrimination; chronic low back pain; disability; injustice perception; pain catastrophizing

[Available on 2021-03-25]

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