An Intersectional Identity Approach to Chronic Pain Disparities Using Latent Class Analysis
Chronic pain is a highly prevalent and costly condition with substantial negative effects. However, health care differences exist in prevalence, pain assessment, treatment, and outcomes based on demographic characteristics. There has been a recent increase in health disparity research. Many studies have examined the relationships between independent factors of disparity (e.g., race, sex, income, age, etc.) and health outcomes. Research is limited on the interaction of these independent factors (e.g., female Black/African-American, low-income older adult, etc.). Given the high frequency of individuals with multiple disparity factors, applying an intersectional identity approach to chronic pain disparity research is important. Latent class analysis (LCA) examined chronic pain disparities with an intersectional identity theory approach in the Learning About My Pain (LAMP) trial, a randomized comparative effectiveness study of group-based psychosocial interventions (PCORI Contract #941, Beverly Thorn, PI; clinicaltrials.gov identifier NCT01967342) for patients receiving care for chronic pain at low-income clinics in rural and suburban Alabama. LCA results suggested a 5-class model with meaningful differences in factors related to disparities. Cross-sectional results highlighted the importance of SES, age, and race in the experience of chronic pain. The latent disparity profiles varied by pre-treatment chronic pain functioning and there was some evidence that individuals with moderate disparities (i.e., low literacy/education, older Black/African-American adults, and disability) benefited more from Cognitive-Behavioral Therapy (CBT) than Pain Education (EDU). There were no significant heterogeneity of treatment effects when examining CBT or EDU versus Usual-Care (UC). The intersectional identity theory approach provided an integrated picture of chronic pain disparities and increased information for future treatment adaptations that meet the specific needs of individuals with similar social identities.